Treatment of traumatic conditions of the femur using the Huckstep nail

The Huckstep nail is essentially an intramedullary nail. We assessed 53 patients treated for complex fractures of the femur between 1982 and 1988. Our series included 41 acute fractures, seven malunions or nonunions and five pathological fractures. We modified the Huckstep technique by using a traction table and image intensification for closed reduction and introduction of screws into the femoral neck. However, half of our patients required open reduction. All but one of the acute fractures united, occasionally after some delay. We were able to achieve lengthening of between 3cm and 5cm where this was indicated but all these patients' fractures required bone grafting before uniting. Despite extensive surgical exposure knee function was surprisingly good. Complications included one broken nail, 12 fractured distal screws and 3 cases of intra-operative "bursting" of the distal cortex. The procedure was lengthy and blood loss considerable but no sepsis occurred. Although locking nails have now largely superseded the Huckstep nail, it remains useful for special cases where a short implant is needed, or in situations where specialised equipment such as image intensifiers are unavailable.