Treatment of femoral shaft fractures with monoaxial external fixation in polytrauma patients

Abstract

Background: Femoral shaft fractures, typical in younger people, are often associated with polytrauma followed by traumatic shock. In these situations, despite intramedullary nailing being the treatment of choice, external fixation could be used as the definitive treatment. The aim of this study is to report evidence regarding definitive treatment of femoral shaft fractures with monoaxial external fixation. Methods: Between January 2006 and December 2015, 83 patients with 87 fractures were treated at the Department of Orthopaedics and Traumatology CTO of Turin, with a monoaxial external fixation device. Mean age at surgery, type of fracture, mean follow-up, time and modalities of treatment, non-weight bearing period, average healing, external fixation removal time, and complications were reported. Results: The average patient age was 31.43±15.19 years. In 37 cases (42.53%) the right femur was involved. 73 (83.91%) fractures were closed, and 14 (16.09%) were open. The average follow-up time was 61.07±21.86 weeks. In 68 (78.16%) fractures the fixation was carried out in the first 24 hours, using a monoaxial external fixator. In the remaining 19 cases, the average delay was 6.80±4.54 days. Mean non-weight bearing time was 25.82±27.66 days (ranging from 0 to 120). The 87 fractures united at an average of 23.60±11.37 weeks (ranging from 13 to 102). The external fixator was removed after an average of 33.99±14.33 weeks (ranging from 20 to 120). Reported complications included 9.19% of delayed union, 1.15% of septic non-union, 5.75% of malunion, and 8.05% cases of loss of reduction. Conclusions: External fixation of femoral shaft fractures in polytrauma is an ideal method for definitive fracture stabilization, with minimal additional operative trauma and an acceptable complication rate.

Definitive Treatment of Femoral Shaft Fractures: Comparison between Anterograde Intramedullary Nailing and Monoaxial External Fixation

“…In fact, even if there are no significant differences in union times between the two groups, considering only the patients healed before 30 weeks and excluding delayed unions, the EF group had a mean union time 4 weeks less than the IMF group (20 vs 24 weeks). Average union times were in accordance with data from the published literature [7,8,9]. The AAOS suggests allowing immediate weight-bearing also to patients with comminute fractures treated with intramedullary nailing or external fixation, delaying it when fixation plates and screws are used [16].…”

“…The average surgical duration was 80 minutes in the IMN group and 50 minutes in the EF group ( p < 0.0001). In the literature [2,8], the average surgical duration was 60 minutes for intramedullary nailing and 40 minutes for monoaxial external fixation.…”

“…There are many conditions in which intramedullary nailing cannot be performed—for example, in polytrauma patients whose conditions require major surgical procedures. In these cases, some surgeons perform external fixation as a definitive treatment for femoral shaft fractures to avoid further surgical sessions, reducing complications rates and costs [7,8,9].…”

Long bone fracture reduction and deformity correction using the hexapod external fixator with a new method: a feasible study and preliminary results

“…For trauma-control and definitive management of polytrauma with complex fractures, the external fixation played a crucial role in recent years [ 2 , 29 ]. Alhammoud et al [ 2 ] solely applied different uniplanar or multiplanar external fixators as primary and definitive management for a large number of 955 patients, concluding that external fixation was a reliable method for open long bone shaft fractures caused by high energy trauma.…”

“…Alhammoud et al [ 2 ] solely applied different uniplanar or multiplanar external fixators as primary and definitive management for a large number of 955 patients, concluding that external fixation was a reliable method for open long bone shaft fractures caused by high energy trauma. Testa et al [ 29 ] conducted a monoaxial external fixation treatment in 83 patients with femoral shaft fractures. The satisfactory outcomes manifested it was an ideal method, including advantages of minimal additional operative injury and an acceptable complication rate.…”