Results of internal elastic plate osteosynthesis of simple femoral shaft fractures in polytraumatized patients.

Abstract

Primary medullary nailing of femoral fractures is burdened by the risk of central and pulmonary complications in patients with polytrauma, especially in conjunction with craniocerebral or thoracic trauma. This also applies to unreamed medullary nailing. Primary treatment with external fixation necessitates secondary surgery with an altered procedure, the timing of which is not predictable. Plate osteosynthesis with anatomical repositioning of the fragments and rigid fixation is a technically demanding procedure, but can lead to fragment necrosis due to fragment denudation. In a prospective study conducted from 1 September 1994 to 30 June 1996 on 17 polytraumatized patients (average ISS:30 points), simple femoral stem fractures (A-1 to B-3 of the AO-classification) were stabilized by elastic plate osteosynthesis using biological technique. While cautiously preserving the periosteal and muscle connections to the bone, a plate is inserted as a bridge without any interfragmentary compression. At least two to four holes are left free in the center of the plate. This allows micro-movements in the fracture gap without the risk of material fatigue. All of the fractures were immediately stabilized on the day of the accident. In four patients with severe craniocerebral trauma or manifest shock, the procedure was changed to plate osteosynthesis after application of primary external fixation. Secondary injuries (joint and pelvic fractures or craniocerebral trauma) delayed early loading in 12 cases. Four patients were mobilized postoperatively under partial loading. A fixation callus was radiologically detectable on average 6 weeks after surgery. This often allowed additional loading, depending on the secondary injuries. Full loading was possible after 14 weeks. Complications included one case of surgery-related malpositioning, one soft-tissue infection, one case of plate detachment after a fall and one case of periosseous calcification. There were no cases of bone infections or pseudoarthroses. Elastic plate osteosynthesis is thus a conservative osteosynthesis procedure with a low complication rate in polytraumatized patients, even in those with simple femoral fractures.