Nail–Schanz pin integrated external distraction technique during intramedullary nailing of comminuted femoral shaft fracture

Background: Comminuted femoral shaft fractures present significant technical challenges in restoring length, alignment, and rotation. We present a case in which a nail-Schanz pin integrated external distractor was used to facilitate length restoration, controlled reduction, and maintenance of alignment. Case presentation: A 36-year-old male sustained a high-energy comminuted femoral shaft fracture with extensive posterior degloving injury following a motorcycle accident. Closed reduction and statically locked intramedullary nailing were performed using a nail-Schanz pin integrated external distractor. Gradual distraction allowed restoration of femoral length, and fine corrections of alignment and rotation were performed using a distractor under fluoroscopic guidance. Results: Radiographic union was achieved at 9 months postoperatively. Final assessment demonstrated negligible limb length discrepancy (+7 mm), 3° varus coronal alignment, neutral sagittal alignment, and no clinically significant rotational malalignment. The patient demonstrated a normal, pain-free gait and regained full range of motion of the hip and knee. Conclusions: This case demonstrates that a nail-Schanz pin integrated external distractor can be a useful adjunct during intramedullary nailing of comminuted femoral shaft fractures, enabling precise restoration of length and stable maintenance of reduction.