Retrospective review of 133 dynamic femoral intramedullary nailings performed at a level-I trauma center (1983–1987), examining the incidence and causes of surgical decision-making errors that led to loss of fixation when static interlocking was available but not used.
This paper reframed the default decision for femoral nailing: before Brumback 1988, surgeons sought reasons to lock; after it, the field accepted that you must find reasons not to lock.
Published at the precise moment interlocking nails were becoming standard, it provided the first clinical failure-rate data for dynamic nailing in the interlocking era and validated the Winquist-Hansen comminution classification as the governing framework for fixation choice — a relationship that Winquist et al.'s own 1984 series (520 cases, JBJS) had proposed but not tested against failure outcomes.
The practical protocols it introduced — intraoperative fluoroscopy at each reaming pass, mandatory postoperative radiograph review under anesthesia, and weekly radiographic follow-up for three to six weeks after dynamic nailing — were adopted into trauma fellowship teaching and remain embedded in current AO/OTA nail selection principles.
Retrospective review of 133 dynamic femoral intramedullary nailings performed at a level-I trauma center (1983–1987), examining the incidence and causes of surgical decision-making errors that led to loss of fixation when static interlocking was available but not used.
This paper reframed the default decision for femoral nailing: before Brumback 1988, surgeons sought reasons to lock; after it, the field accepted that you must find reasons not to lock.
Published at the precise moment interlocking nails were becoming standard, it provided the first clinical failure-rate data for dynamic nailing in the interlocking era and validated the Winquist-Hansen comminution classification as the governing framework for fixation choice — a relationship that Winquist et al.'s own 1984 series (520 cases, JBJS) had proposed but not tested against failure outcomes.
The practical protocols it introduced — intraoperative fluoroscopy at each reaming pass, mandatory postoperative radiograph review under anesthesia, and weekly radiographic follow-up for three to six weeks after dynamic nailing — were adopted into trauma fellowship teaching and remain embedded in current AO/OTA nail selection principles.