The utilization of the Holt nail for proximal femoral fractures. A study of one hundred and forty-six patients

Important technical requirements for the successful use of the Holt nail are outlined. Emphasis was placed upon obtaining and maintaining a good reduction of the fracture with special attention given to the integrity of the calcar femorale. The Holt nail provided an excellent means of treating base-of-the-neck fractures and simple intertrochanteric fractures. This method was satisfactory in treating comminuted intertrochanteric fractures. Early weight-bearing was possible with all of the three types of fractures. There was no advantage in utilizing a Holt nail over other types of nails in treating comminuted subtrochanteric femoral fractures. The highest incidence of implement complication was in this group. Minimum migration of the nail was observed in all patients as impaction occurred with weight-bearing. Penetration was a complication in 8 per cent of patients. No fracture of the nail was observed, but fracture of the bolts occurred in nine patients. Measures to prevent these complications were discussed. There were thirteen surgical infections, and the mortality rate was similar to that of other series. The advantages of early weight-bearing were discussed.