To analyze the clinical and radiological results of Huckstep nailing in the treatment of acute femoral fractures and femoral nonunion, and to report the easy and non-fluoroscopic technique of targeting the locking screw holes by making double cortical windows.

This study examined a total of fifteen femoral fractures treated with Huckstep nailing between January 1999 and January 2004. The fractures included six acute fractures (five closed and one open) and nine nonunions (four infective and five aseptic). The reoperative status, number of interventions, time to union and complications were analyzed. Ten male and 5 female patients with an average age of 42 years (range, 18-70) were followed up for a mean of 26 months (range, 16 months to 6.4 years). A new method of double cortical windows for targeting the screw holes were performed in seven cases without fluoroscopic aid.

Radiographic union was achieved after a mean of 15.3 weeks in those with an acute fracture and after a mean of 24.6 weeks in those with nonunion. One open fracture was fixed initially using a monofixator followed by Huckstep nail 4 weeks later when the open wound had healed. A bone graft was performed in two cases of nonunion, and Hydroxyapatite/Tricalcium phosphate granules were grafted in three cases of nonunion. Partial knee ankylosis resulted in 6 cases of nonunion at the final follow-up because the nonunion cases had undergone an average of 4.3 surgical procedures at other hospitals over an average of 11.8 months before performing Huckstep nailing. One acute case without proximal screw fixation resulted in dynamization and femoral shortening of 2 cm.

Huckstep nailing provides stable fixation sufficient to enable early knee motion and weight bearing until the fracture heals in both acute fracture and nonunion. The new method of double cortical windows allows the easy targeting of screw holes without fluoroscopic aid.