Management of compound fractures of shaft femur: a study of 55 cases

Authors

  • Gaurav Singla Department of Orthopaedics, M.M Medical College and Hospital, Ambala Cantt., Haryana, India
  • Amita Aggarwal Department of Periodontics, M.M Medical College and Hospital, Ambala Cantt., Haryana, India
  • Ravinder Singh Department of Orthopaedics, M.M Medical College and Hospital, Ambala Cantt., Haryana, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20164160

Keywords:

Compound femoral shaft fractures, Interlocked nailing, Plating, External fixator

Abstract

Background: Compound femoral shaft fractures are a major cause of morbidity and mortality. Conservative treatment necessitates a long stay in hospital for traction and subsequent immobilization and chances of wound infection are much higher. The objective of this study was to find out the outcome of treatment of open femoral shaft fractures by various modalities like interlocked nailing, plating and external fixation.

Methods: Fifty five patients with open femoral shaft fractures were treated under spinal or general anaesthesia. These fractures were in proximal one third (n=3), middle third (n=29), distal third (n=21). Fifty patients underwent surgery within 5 days of injury. Patients were followed for a minimum of 12 Months.

Results: Patients achieved union in an average time of 20 weeks (range 17 to 24 weeks). Full weight bearing was started in a mean time of 16 weeks. Mean duration of hospital stay was 20 days. Complications were occurred in ten patients (4 non-unions and 3 patients with deep infection and 3 patients developed chronic osteomyelitis).

Conclusions: The results were excellent in 31, good in 13, fair in 3 and poor in 7 patients while one patient lost follow up as he was from far off place. We concluded that open femoral shaft fracture can be well managed by surgical intervention.

Author Biography

Gaurav Singla, Department of Orthopaedics, M.M Medical College and Hospital, Ambala Cantt., Haryana, India

ORTHOPAEDICS

ASSISTANT PROFESSOR

CONSULTANT JOINT REPLACEMENTS SURGEON

References

Pape HC, Roberb CS, Jones AL, Malkani AI, Rodriquez JL. Damage control orthopaedics, evolving concepts in the treatment of patient who have sustained orthopaedic trauma. J Bone Joint Surg. 2005;87:434-49.

Tscherne H, Regel G. Care of polytraumatised patient. J Bone Joint Surg. 1996;78(5):840-52.

McNeur JC. The management of open skeletal trauma with particular reference to internal fixation. J Bone Joint Surg. 1970;52:54-60.

Chapman M, Mahoney M. The role of intramedullary fixation in open fractures. Corr. 1986;212:18-22.

Chapman MW, Mahoney M. The role of early internal fixation in the management of open fractures. Clin Orthop Relat Res. 1979;138:120–31.

Bone LB, Johnson KD, Weigelt J, Scheinberg R. Early versus delayed stabilization of femoral fractures. A prospective randomised study. J Bone Joint Surg. 1989;71:336-40.

Pape HC, Giannoudis P, Krettek C. The timing of fracture treatment in polytrauma patients and relevance of damage control orthopaedic surgery. The Am J of Surgery. 2002;183(6):622-9.

Goris RJ, Gimbrere JS, van Niekerk JL, Schoots FJ, Booy LH. Improved survival of multiply injured patients by early internal fixation and prophylactic mechanical ventilation. Injury. 1982;14:39-43.

Johnson KD, Cadambi A, Seibert GB. Incidence of adult respiratory distress syndrome in patients with multiple musculoskeletal injuries. Effects of early stabilization of fractures. J Trauma. 1985;25:375-84.

Meek RN, Vivoda EE, Pirani S. Comparison of the mortality of patients with multiple injuries according to type of fracture treatment-a retrospective age and injury matched series. Injury. 1986;17:2-4.

Smith JEM. Results of early and delayed internal fixation of fractures of shaft of femur. J Bone Joint Surg. 1946;46:28-31.

Smith JEM. Results of early and delayed internal fixation of fractures of shaft of long bones. J Bone Joint Surg. 1974;56:469-77.

Thoresen BO, Alho A, Ekeland A, Strømsøe K, Follerås G, Haukebø A. Interlocking intramedullary nailing in femoral shaft fractures. A report of fort-eight cases. J Bone Joint Surg. 1985;67:1313-20.

Sir Kuntscher G. The intramedullary nailing of femur fractures. Clin Orthop Relat Res. 1968;(60):5-11.

O’ Brien PJ, Meek RN, Powell JN, Blachut PA. Primary intramedullary nailing of open femoral shaft fractures. J Trauma. 1991;31(1):113-6.

William M JR. Treatment of sepsis after intramedullary nailing of fractures of femur. Clin Orthop Relat Res. 1968;60:87-94.

Browner BD. The Grosse-Kempf locking nail. Contemp Orthop. 1984;8:17-25.

Winquist RA, Hansen ST, Clawson DK. Closed Intramedullary nailing of femoral fractures. A report of five hundred and twenty cases. J Bone Joint Surg. 1984;66:529-39.

Johnson KD, Johnston DWC, Parker B. Comminuted femoral shaft fractures: Treatment by roller tration, cerclage wires and an intramedullary nail, or an interlocking intramedullary nail. J Bone Joint Surg. 1984;66:1222-35.

Chapman MW. The use of immediate internal fixation in open fractures. Clin Orthop Relat Res. 1980;11:579-91.

Chapman MW. Management of open fractures and complications. Part 3. Role of bone stability in open fractures. In instructional course lectures. AAOS. 1982;31:75-87.

Ruedi TP, Luscher JN. Results after internal fixation of comminuted fractures of femoral shaft with DC plates. Clin Orthop Relat Res. 1979;138:74-76.

Alonzo J, Geissler W, Hughes JL. External fixation of femoral fractures. Indications and limitations. Clin Orthop.1989;241:83-8.

Murphy CP, Ambrosia RD, Dabezies EJ, Acker JH, Shoji H, Chuinard RG. Complex femur fractures. Treatment with the wagner external fixation device or the Grosse-Kempf interlocking nail. J Trauma. 1988;28:1553-61.

Dabezies EJ, Ambrosia RD, Shoji H, Norris R, Murphy G. Fractures of femoral shaft treated by external fixation with wagner device. J Bone Joint Surg. 1984;66:360-4.

Bastiani GD, Aldegheri R, Brivio LR. The treatment of fractures with a Dynamic axial fixator. J Bone Joint Surg. 1984;66(4):538-45.

Gustilo RB, Anderson JT. Open fractures grading. J Bone Joint Surg. 1976;58:453-8.

Bach AW, Hansen ST. Plate versus External fixation in severe open tibial fractures. A randomised trial. Clin Orthop Relat Res. 1989;241:89-94.

Clancey GJ, Hansen ST JR. Open fractures of tibia. A review of one hundred and two cases. J Bone Joint Surg. 1978;60:118-22.

Jensen JS, Johansen J, Morch A. Middle third femoral fractures treated with intramedullary nailing or AO compression plating. Injury. 1977;8:174-81.

Rittmann WW, Schibli M, Matter P, Allgower M. Open fractures. Long term results in 200 consecutive cases. Clin Orthop Relat Res. 1979;138:132-40.

Ruedi TP, Luscher JN: Results after internal fixation of comminuted fractures of femoral shaft with DC plates. Clin Orthop Relat Res. 1979;138:74-6.

Wade PA, Campbell RD. Open versus closed methods in treating fractures of the leg. Am J Surg. 1958;95:599-616.

Mageryl F, Wyss A, Brunner C, Binder W. Plate Osteosynthesis of femoral shaft fractures in adults. A follow up study. Clin Orthop. 1979;138:62-73.

Chapman MW. The use of immediate internal fixation in open fractures. Orthop Clinics North America. 1980;11:579-91.

Robson MC, Duke WF, Krizek TJ. Rapid bacterial screnning in the treatment of civilian wounds. J Surg Res. 1973;14:426-30.

Gustilo RB. Principles of management of open fractures. In management of open fractures and their complications. WB Saunders monographs in clinical orthopaedics. 1982;4:19.

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Published

2016-11-19

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Original Research Articles