Technical difficulties with the Brooker-Wills nail in acute fractures of the femur.

In this series of 41 cases of acute fractures of the femur treated with the Brooker-Wills nail, 20 technical problems with insertion or removal of the nail occurred in 19 of the total. Final outcomes were determined in 33 cases followed for 1 year or more. Technical difficulties had a deleterious effect on the outcome in three of these 33 cases. Mechanical failure seems to be a significant problem with the Brooker-Wills system in this and other series. We found that bending of the proximal nail during the insertion, breaking of the tip of the distal fixator inserter, and detachment of the blades from the fixator shaft had occurred. Although satisfactory results were obtained in this series, comparable to other "start-up" series, it is our opinion that the advantages of the Brooker-Wills nail over other interlocking nails are outweighed by the disadvantages of difficult insertion and removal.