The treatment of fractures in the femoral shaft has undergone a process of evolution in which five main mechanical principles have been developed. The older methods are safer from the standpoint of infection and do not require elaborate operative facilities. However, they require greater manipulative skill to achieve an equally good anatomic result, and in some types of fractures such a result is a physical impossibility by closed methods.
The oldest method, that of reduction by manual traction and manipulation followed by external fixation, was extensively employed by Hippocrates1 and his group. It has been commonly used since, particularly after Mathijsen's contribution of plaster bandages in 1852. As Mr. H. Osmond Clarke2 has said, it is still the safest method; yet its use in this country is chiefly limited to fractures of the femur in children because of the difficulty in maintaining satisfactory alinement. Joint stiffness following immobilization
STREET DM. MEDULLARY NAILING OF THE FEMURComparative Study of Skeletal Traction, Dual Plating and Medullary Nailing. JAMA. 1950;143(8):709–714. doi:10.1001/jama.1950.02910430001001