Abstract
Background: Femoral shaft fractures result from high-energy trauma. Despite intramedullary nailing (IMN) representing the gold standard option of treatment, external fixation (EF) can be used temporarily for damage control or definitively. The purpose of this study is to compare two different options, anterograde IMN and monoaxial EF, for the treatment of femoral shaft fractures. Methods: Between January 2005 and December 2014, patients with femoral shaft fractures operated on in two centers were retrospectively evaluated and divided into two groups: the IMN group (n = 74), and the EF group (n = 73). For each group, sex; laterality; age; and AO classification type mean follow-up, mean union time, and complications were reported. Results: Both groups were found to have no statistical differences (p > 0.05) in sex, laterality, age, and AO classification types. In the IMN group the average surgery duration was 79.7 minutes (range 45–130). The average time for bone union was 26.9 weeks. Major complications occurred in 4 (5.4%) patients. In the EF group the average follow-up duration was 59.8 months (range 28–160). The average time for bone union was 24.0 weeks. Major complications occurred in 16 (21.9%) patients. Conclusions: IMN is the gold standard for definitive treatment of femoral shaft fractures. In patients with severe associated injuries, EF should be a good alternative.
Highlights
Femoral shaft fracture incidence is approximatively 0.01% and results from high-energy trauma, often associated with polytrauma, comminuted fractures, and open fractures [1,2]
The intramedullary nailing (IMN) group was composed of 74 patients, (49 (66.2%) males and 25 (33.8%) females)
Fracture involved the right side in 41(55.4%) patients and the left in 33 (44.6%)
Summary
Femoral shaft fracture incidence is approximatively 0.01% and results from high-energy trauma, often associated with polytrauma, comminuted fractures, and open fractures [1,2]. External fixation is not frequently performed to treat femoral diaphyseal fractures and there have been few studies performed on this topic, in which its use is mainly indicated to temporarily stabilize the fracture in patients who suffer polytrauma or open fractures [5] In such instances external fixation can be used as a temporary treatment and subsequently converted into intramedullary nailing within two weeks after the trauma [6]. 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]. In patients with severe associated injuries, EF should be a good alternative
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