Strategies in Trauma and Limb Reconstruction

Register      Login

VOLUME 2 , ISSUE 1 ( April, 2007 ) > List of Articles

Original

Internal femoral osteosynthesis after external fixation in multiple-trauma patients

F. Lavini, E. Carità, C. Dall Oca, R. Bortolazzi, G. Gioia, L. Bonometto, A. Sandri, P. Bartolozzi

Keywords : Femoral fractures, Damage control orthopaedics, Internal femoral osteosynthesis, External fixation

Citation Information : Lavini F, Carità E, Dall Oca C, Bortolazzi R, Gioia G, Bonometto L, Sandri A, Bartolozzi P. Internal femoral osteosynthesis after external fixation in multiple-trauma patients. 2007; 2 (1):35-38.

DOI: 10.1007/s11751-007-0012-x

License: CC BY-NC-SA 4.0

Published Online: 01-09-2019

Copyright Statement:  Copyright © 2007; The Author(s).


Abstract

In this study the authors evaluate the results of internal synthesis of femoral fractures in polytraumatised patients initially treated by external fixation (EF). From January 2002 to December 2005, 39 femurs in 37 polytraumatised patients (average age 34.2 years, range 18-44) with closed fractures and an ISS>20 were initially treated with EF. There were three groups: Group A, 13 cases when conversion to internal osteosynthesis occurred after 4-7 days (average 5.6 days); Group B, 11 cases with a 4-6-month interval before internal osteosynthesis, and after investigation using MRI and scintigraphy with labelled leucocytes; Group C, the remaining cases treated definitively with EF. Time of healing, lower limb function, time of return to previous activities and short and long-term complications were evaluated at the follow-up. The average time of follow-up was 23 months. In Group A the time of bone healing was 123 days; there were no events of embolism but one case of pseudoarthrosis and one case of instrument failure. In Group B the time of bone healing was 274 days, with one case of pseudoarthrosis and one case of deep infection. In Group C the average healing time was 193 days, with 3 cases of screw (half-pin) osteolysis. Functional recovery was delayed by the presence of other fractures. EF is a simple, quick and safe procedure to stabilise fractures in polytraumatised patients. According to damage control orthopaedic (DCO) concepts, it is possible to replace EF with internal synthesis after an interval as this reduces the risks of internal osteosynthesis when performed in the emergency period. EF can also be maintained as definitive treatment but should a change to internal synthesis be needed, it is possible to do it safely after excluding bone infection.


PDF Share
  1. Pape HC, Tscherne H (2000) Early definitive fracture fixation, pulmonary function and systemic effects. In: Baue AE, Faist E, Fry M (eds) Multiple organ failure. Springer Verlag, New York, pp 279-290
  2. Bone LB, Johnson KD, Weigelt J, Scheinberg R (1989) Early versus delayed stabilization of fractures. Aprospective randomized study. J Bone Joint Surg Am 71:336-340
  3. Goris RJA, Gimbrere JSF, Niekerk JLM et al (1982) Early osteosynthesis and prophylactic mechanical ventilation in the multitrauma patient. J Trauma 22:895-903
  4. Talucci RC, Manning J, Lampard S (1983) Early intramedullary nailing of femoral shaft fractures: a cause of fat embolism syndrome. Am J Surg 146:107-111
  5. Johnson KD, Cadambi A, Seibert GB (1985) Incidence of adult respiratory distress syndrome in patients with multiple musculoskeletal injuries: effect of early operative stabilization of fractures. J Trauma 25:375-384
  6. Ecke H, Faupel L, Quoika P (1985) Gedanken zum Zeitpunkt der Operation bei Frakturen des Oberschenkelknochens. Unfallchirurgie 11:89-93
  7. Rotondo M, Schwab CW, McGonigal M et al (1993) Damage control: an approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma 35:375-382
  8. Pape HC, Hildebrand F, Pertschy S et al (2002) Changes in the management of femoral shaft fractures in polytrauma patients: from early total care to damage control orthopedic surgery. J Trauma 53:452-461
  9. Roumen R, Hendriks T, ven der Ven-Jongekrijk et al (1993) Cytokine patterns in patients after major vascular surgery, hemorrhagic shock, and severe blunt trauma. Ann Surg 218:769-776
  10. Roumen R, Redl H, Schlag G (1995) Inflammatory mediators in relation to the development of multiple organ failure in patients after severe blunt trauma. Crit Care Med 23:474-480
  11. Waydhas C, Nast Kolb D, Trupka A, Zettl R (1996) Posttraumatic inflammatory response, secondary operations, and late organ failure. J Trauma 40:624-631
  12. Staub NC (1974) Pulmonary edema. Physiol Rev 54:678-684
  13. Pape HC, van Griensven M, Rice J et al (2001) Major secondary surgery in blunt trauma patients and perioperative cytokine liberation: determination of the clinical relevance of biochemical markers. J Trauma 50:989-1000
  14. Pape HC, Stalp M, Dahlweit M et al (1999) Welche primäre Operationsdauer ist hinsichtlich eines “Borderline-Zustandes” polytraumatisierter Patienten vertretbar? Eine prospektive Evaluation des Traumaregisters der DGU. Unfallchirurg 102:861-869
  15. Pape HC, Giannoudis P, Krettek C (2002) The timing of fracture treatment in polytrauma patients: relevance of damage control orthopedic surgery. Am J Surg 183:622-629
  16. Scalea TM, Boswell SA, Scott JD et al (2000) External fixation as a bridge to intramedullary nailing for patients with multiple injuries and with femur fractures: damage control orthopaedics. J Trauma 48:613-623
  17. Nowotarski PJ, Turen CH, Brumback RJ, Scarboro JM (2000) Conversion of external fixation to intramedullary nailing for fractures of the shaft of the femur in multiply injured patients. J Bone Joint Surg Am 82:781-788
  18. Alonso J, Geissler W, Hughes JL (1989) External fixation of femoral fractures. Indications and limitations. Clin Orthop Relat Res 241:83-88
  19. Murphy CP, D'Ambrosia RD, Dabezies EJ et al (1988) Complex femur fractures: treatment with the Wagner external fixation device or the Gross-Kempf interlocking nail. J Trauma 28:1553-1561
  20. Rooser B, Bengtson S, Herrlin K, Onnerfalt R (1990) External fixation of femoral fractures: experience with 15 cases. J Orthop Trauma 4:70-74
  21. Giannoudis PV (2003) Aspects of current management. Surgical priorities in damage control in polytrauma. J Bone Joint Surg Br 85:478-483
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.