The Holland nail®: A universal implant for fractures of the proximal femur and the femoral shaft

Objective: To study the possibilities and outcomes for hip and femoral fractures treated with the universal Holland nail®. Design: Retrospective study from November 1998 to December 2001. Setting: Department of Traumatology, Erasmus Medical Centre, Rotterdam. Subjects: 112 patients with 115 fractures of the proximal femur and/or the femoral shaft, due to traumatic causes or to metastatic disease. Main outcome measures: Implant possibilities of the Holland nail® and observed complications. Results: 110 patients presented for primary fracture treatment. Two patients were treated secondarily. In three patients, both femora were fractured. Nineteen patients suffered a pathological (impending) fracture. During operation we dealt with 27 minor difficulties. Postoperatively, in 80% of the cases full weight-bearing was allowed. Three patients developed wound infection. In follow-up, 14 patients were lost and two died. The remaining 77 patients (80 fractures) were available for follow-up with regard to fracture healing. Overall consolidation was achieved in 89% of the patients within 12 months. Two patients developed perforation of the femoral head, necessitating removal of the hip screws, and in two patients failure of the nail was seen. Overall, 19 patients needed a non-planned secondary intervention, of which 12 were deemed a minor procedure (e.g. 'dynamisation by distal screw removal'). Conclusion: The Holland nail® is technically easy to use for any type of hip and femoral-shaft fracture.

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