Complex Femoral Fractures Research Articles

A preclinical model of post-surgery secondary bone healing for subtrochanteric femoral fracture based on fuzzy interpretations.

Mechanobiology plays an essential role in secondary bone fracture healing. While the introduction of newer type of plates, e.g. locking plate (LP), is becoming increasingly popular for complex femoral fractures, the conventional technique involving dynamic compression plate (DCP) remains the standard choice. The difference between the two techniques lies primarily in their screw fixation mechanisms. The present study applied 3D dynamic fracture healing scheme modelled on a subtrochanteric femur fracture, regulated by both finite element (FE) analysis and Fuzzy logic control in order to understand the spatio-temporal healing phenomena for both LP and DCP. The study further examined the influence of the two screw fixation mechanisms in determining the comparative progression of fracture healing. The problem was solved iteratively in several healing steps running in loop and accordingly, the local tissue concentrations and material properties were updated. The predicted results accorded well with various previous experimental observations. The study found an initial delay in healing associated with DCP. However, as the healing progressed, there was no significant difference in overall callus modulus. The presented preclinical model may further help predict bone healing for different implantation techniques, and thus can serve as a non-invasive tool for evaluating relative merits of extramedullary plating techniques.

Radiographic outcomes of the treatment of complex femoral shaft fractures (AO/OTA 32-C) with intramedullary nailing: a retrospective analysis of different techniques.

ObjectivesTo assess the results of open versus closed reduction in intramedullary nailing (IMN) for complex femoral fractures (Arbeitsgemeinschaft für Osteosynthesefragen Foundation/Orthopaedic Trauma Association [AO/OTA]: 32-C) and to determine the factors involved in bone healing.MethodsThis retrospective study involved 47 consecutive patients with complex femoral diaphyseal fractures who underwent reduction and fixation.ResultsAll open-reduction and 12 closed-reduction patients (52.17%) had an anatomical-to-small gap. The closed-small group had the highest bone union rate (100%), followed by the open-reduction (79.17%) and closed-large groups (72.73%); intergroup differences were significant. The closed-small group had the shortest mean union time (7.31 months), followed by the open-reduction group (7.58 months). The closed-large group had a significantly longer union time (9.75 months) than those in the closed-small and open-reduction groups. Femoral radiographic union scores in the closed-small and open-reduction groups were similar at three timepoints; scores were higher than those in the closed-large group, with a significant difference 6 and 9 months post-operatively.ConclusionIMN with closed reduction for complex femoral shaft fractures had better outcomes and fewer complications versus open reduction. For unsatisfactory closed reduction outcomes (i.e., residual gap >10 mm), minimally invasive techniques or open reduction with minimal stripping should be considered.

Role of mini-invasive bridge plate in the complex femoral fracture in school going children: A prospective clinical study of 30 cases.

Objective:Pediatric femoral fracture including supracondylar and subtrochanteric fracture constitutes 1.6% of all paediatric fracture. Elastic nails remain the standard treatment of choice in a midshaft transverse femoral fracture in children weighing less than 45 kg. But in subtrochanteric and spiral femoral fracture, the failure rate of elastic nails are quite high. Hence, in accordance with AAOS guidelines, we treated complex femoral fracture in children with submuscular mini-invasive bridge plate because of its advantage of minimal incision, early union with proper alignment and lower failure.Material and Methods:We retrospectively reviewed 30 complex femur fracture in children treated with Submuscular bridge plate by mini-invasive approach. Patients were analysed according to their age, type of fracture, time of union in weeks, complication and results were evaluated with modified Flynn's criteria.Result:Out of 30 patients 28 were boys and 2 were females, with an average age of 11.5 years in which Spiral fracture (n = 12), subtrochanteric fracture (n = 9), Complex Shaft fracture (n = 10). All fracture united well on an average of 11 weeks. And 29 patients has excellent results and in 1 patient there is Acceptable result. The single complication was 3 mm limb lengthening but it didn't change gait of the patient.Conclusion:Mini invasive bridge plating is an easy and soft tissue preserving procedure for managing complex femoral fracture in children. It has shown promising results in achieving union without any major complication. We strongly recommend the SBP in a complex femoral fracture in children.

Characterization of novel intramedullary nailing method for treating femoral shaft fracture through finite element analysis.

Femoral shaft fracture is one of the most common types of fracture encountered in the clinic. For certain complex femoral shaft fractures, the traditional intramedullary nail may not provide sufficient stability. Therefore, novel intramedullary nail systems are required. The femur 3D model and the internal fixation model were designed using Mimics 17.0 (Materialise), Geomagic Studio 2012 (Raindrop) and Solidwork 2016 (Dassault) software. The validity of the models was verified through comparison with previous data in silico. To further simulate the comminuted femoral shaft fracture, the novel and traditional type of intramedullary nail system were included in the finite element analysis with the software. The displacement and stress distribution of the two internal fixations were compared using Abaqus 6.14 (Dassault) software. The effectiveness of the model was verified. The stress at the fixed end of the novel intramedullary nail system was greater than that at the fixed end of the traditional intramedullary nail system. However, the displacement of the novel intramedullary nail method was smaller than that of the traditional intramedullary nail. The novel intramedullary nail system features good stability and stress stimulation at the broken end, which is beneficial for bone healing. The present study may provide a theoretical basis for the selection of a means of internal fixation in the clinic.

Treatment of Complex Femoral Fractures with the Long Intramedullary Gamma Nail

Abstract The purpose of the current study was to present the authors’ experiences with the long intramedullary Gamma nail in the treatment of patients with complex femoral fractures. Th is retrospective study included 48 patients with complex femoral fractures. All patients had received fracture fixation treatments with long intramedullary Gamma nails from January 2007 to December 2015. The complex fractures of all patients were classified into 3 types, according to the anatomical locations of the fractures. Type I included combined fractures of the shaft and the proximal femur. Type II included segmental fractures. Type III included combined fractures of the shaft and distal femur. According to the Harris Hip Score, 85.4% of our patients had excellent and very good functional outcomes of the operative procedure. Complications occurred in 7 (14.58%) patients. The most common complications occurred in patients with combined fractures of the shaft and distal femur (50%). Based on the findings of this study, we conclude that the clinical and radiological results after the treatment of complex femoral fractures with the long intramedullary Gamma nail show good outcomes, with a high rate of bone union and minimal soft tissue damage. Experience with this procedure is important to prevent and minimise technical complications.

A study on role of intramedullary interlocking nailing in the complex femoral shaft fractures

<p class="abstract"><strong>Background:</strong> Fractures of the shaft of the femur are a major cause of morbidity and mortality in patients who sustain high energy trauma. Morbidity arises from limb shortening, malalignment, knee contractures and other complications of fracture.</p><p class="abstract"><strong>Methods:</strong> The aim of our study is to analyze the results of complex femoral shaft fractures treated by intramedullary interlocking nailing in our institution. Totally 20 cases of complex femoral fractures from 2007-2009 were treated with intramedullary interlocking at Krishanakumar Orthopedic Care Hospital, Nagercoil were included in our study.<strong></strong></p><p class="abstract"><strong>Results:</strong> We found that fracture of femur is most common in 2nd, 3rd and 4th decade of life, with mean age of 35.85 years. Vehicular accident in 17 patients was observed to be the main cause of fracture in our series (85%). 4 patients started full weight bearing at 10th week, 9 patients were able to bear full weight at 12th week, 4 patients at 14th week and 2 at 16th week. Average time of full weight bearing was 12.4 weeks. One patient developed deep infection (osteomyelitis) at 12 weeks and later non union was seen and unable to bear full weight.</p><p class="abstract"><strong>Conclusions:</strong> Intramedullary interlocking nailing for complex femoral fractures has been established worldwide as the gold standard treatment because of its load sharing property, internal splinting, and rotational stability. These contribute the stable osteosynthesis.</p><p class="abstract"> </p>

Treatment of multi-segment fracture of complex femoral shaft with instrument-assisted reduction combined with intramedullary interlocking nail fixation

To investigate the effect of minimally invasive mini-incision and instrumented reduction combined with interlocking intramedullary nailing in the treatment of patients with multi-segment fracture of complex femoral shaft. From January 2013 to January 2016, 32 patients with multiple fractures segments of femoral shaft were treated with instrumentation-assisted reduction combined with interlocking intramedullary nailing, including 22 males and 10 females with an average age of 45 years old ranging 17 to 68 years old. The time from injured to operation was 5 to 10 days with an average of 7 days. After admission, routine tibial tubercle or supracondylar bone traction was performed. The patient's general condition was evaluated, the operation time and intraoperative blood loss were recorded. According to Thorsen femoral fracture morphology evaluation criteria and Hohl knee function evaluation of postoperative efficacy, postoperative fracture healing, complications and postoperative recovery of limb function were observed. All patients were followed up for 6 to 24 months with an average of 12 months. The operative time ranged from 48 to 76 minutes with an average of 67 min. The intraoperative blood loss was 150 to 400 ml with an average of 220 ml. The surgical incisions all achieved grade A healing. The fractures reached the clinical standard of healing. The fracture healing time ranged from 4.2 to 10.8 months with an average of 5.7 months. There were no nonunion, incision infection and internal fixation fracture, failure and other complications. According to Thorsen femoral fracture morphology evaluation criteria, the result was excellent in 28 cases, good in 3 cases, fair in 1 case. According to Hohl knee function evaluation criteria, the result was excellent in 30 cases, good in 2 cases. Instrument-assisted reduction combined with interlocking intramedullary nail fixation is a safe and effective method for the treatment of complex femoral shaft fractures. It has advantages of small trauma, fixed fixation, quick recovery, early postoperative functional exercise.

Primary total knee arthroplasty for acute fracture around the knee.

Relatively poor results have been reported with open reduction and internal fixation of complex fractures around the knee in elderly osteoporotic patients, and primary total knee arthroplasty (TKA) has been proposed as an alternative solution. While limiting the number of procedures, it meets two prerequisites: (1) to save the patient's life, thanks to early weight-bearing, to limit decubitus complications; and (2) to save knee function and patient autonomy, thanks to early knee mobilization. There are 3 main indications: complex articular fractures in elderly patients with symptomatic osteoarthritis prior to fracture; complex articular fractures of the tibial plateau in elderly patients whose bone quality makes internal fixation hazardous; and major destruction of the distal femur in younger patients. Although admitted in emergency, these patients require adequate preoperative management, including a multidisciplinary approach to manage comorbidities, control of anemia and pain, and assessment and management of vascular and cutaneous conditions. Preoperative planning is crucial, to order appropriate implants and materials that may be needed intraoperatively. Surgical technique is based on the basic principles of revision surgery as regards choice of implant, steps of reconstruction, bone defect management and implant fixation. For complex fractures of the distal femur, primary temporary reduction is a useful "trick", to determine the level of the joint line and femoral rotation. Complementary internal fixation may be required in case of diaphyseal extension of the fracture and to prevent inter-prosthetic fractures. In the literature, the results of primary TKA for fracture are encouraging and better than for secondary TKA after failure of non-operative treatment or internal fixation, with lower rates of revision and complications, earlier full weight-bearing and better functional results. Loss of autonomy is, however, frequent, and 1-year mortality is high, especially following complex femoral fractures in the elderly.

Safe zones and a technical guide for cerclage wiring of the femur: a computed topographic angiogram (CTA) study.

Cerclage wiring for reduction of complex femoral shaft fractures can create iatrogenic vascular injury. To describe the anatomical relation of blood vessels to the femur and develop a technical guide for safe passage of cerclage wire. CT lower-limb angiographs (CTA) of 80 patients were reviewed and analysed to identify the superficial femoral artery (SFA) and the deep femoral artery (DFA) as well as the relation of those arteries to the femoral cortex. The total length of the femur was measured and divided into eight equal segments (seven levels). At each level, the medial half of the femur was divided into eight sectors labelled A through H and the position of the SFA and DFA was recorded. The shortest distance between the femoral cortex and the SFA and DFA at each level was measured. The data was analysed using STATA version 10.0. The average total femoral length from the tip of greater trochanter to lateral joint line was 402.98±26.16cm. The average distances from the SFA to the femur (d1) for levels 1 through 7 were 37.20±5.0, 32.09±4.74, 27.13±4.19, 27.71±5.46, 23.71±4.40, 13.63±3.59 and 10.08±3.09mm, respectively. The average distances between the DFA and the femur (d2) for levels 1 through 3 were 26.70±4.13, 14.76±3.27 and 9.58±3.79mm, respectively. The position of the SFA is located in sectors B through E at levels 1-3 and in sectors E through H at levels 4-7 and the position of the DFA located in sectors B through F at levels 1-3. Cerclage wiring should be started from the posterior intermuscular septum at the linea aspera. The safe area is the proximal half (midshaft) of the femur where the SFA and DFA lie at a safe distance from the femur. Between the midshaft and the distal 1/4, insertion of the passer must be done meticulously with the tip kept close to posteromedial cortex. Below the distal 1/4, the tip of the passer should be kept close to the posterior cortex to avoid injury to the SFA and the sciatic nerve.

Complex femoral fractures: management by interlocking nails and percutaneous cancellous screws

Background Complex femoral fractures are fractures involving more than one anatomical region of the femur. Each of these fractures may be fixed with implants selected for each fracture, requiring large incisions. In this study, these fractures were fixed with antegrade interlocking nails and percutaneous cancellous screws. Patients and methods A prospective study was conducted at Mansoura University Emergency Hospital. Twenty-nine skeletally mature patients with complex femoral fractures included in this study were managed with antegrade interlocking nails and percutaneous cancellous screws. The orthopedic trauma association (OTA) classification was used for classifying fractures, and the Gustillo and Anderson classification was used for open fractures. Results All fractures in this study healed without complications. No statistically significant correlations were found between fracture type, fracture level, and healing time. Cases with open fractures of the femoral shaft had longer healing times, which were significant (P=0.03). There were no cases with malunion, femoral neck nonunion, or avascular necrosis of the femoral head. Conclusion Antegrade interlocking nail combined with percutaneous cancellous screws is a potent and effective method for fixing complex femoral fractures.

Minimally invasive plate osteosynthesis (MIPO) of periprosthetic femoral fractures with percutaneous cerclage wiring for fracture reduction: tips and technique

Introduction: Periprosthetic femoral fractures (PPFs) associated at or near a well-fixed femoral prostheses (Vancouver type-B1) present a clinical challenge due to the quality of the bone stock and instability of the fracture. Combining closed reduction techniques with minimally invasive plate osteosynthesis (MIPO) or intramedullary nailing is a technically challenging procedure, especially when dealing with complex femoral fractures such as periprosthetic fractures. Cerclage wiring is a well known adjunct for fracture reduction and fixation. However, it is usually performed by open reduction, requiring wide surgical exposures, that results in soft tissue stripping. Materials and Methods: In our original study 18 patients with periprosthetic femoral shaft fracture (mean age, seventy-four years; range, forty-seven to eighty-four years) were treated with the described percutaneous cerclage wire and MIPO techniques. One patient died two months postsurgery, leaving seventeen patients who were followed for a mean of 13.2 months. Results and Discussion: Four patients sustained a spiral fracture pattern; three, an oblique fracture; and two, a wedge fracture. Closed reduction was successful in all but one case, and took a mean of 24.4 minutes (range, seven to forty-five minutes). The mean total operative time was 103 minutes (range, seventy-five to 140 minutes). Blood loss was <100 ml in all cases. All fractures united at a mean of eighteen weeks (range, sixteen to twenty weeks). No hardware failures were observed; one plate bent 100, but the bending did not progress and the fracture healed uneventfully at sixteen weeks. Seven of the nine patients were able to return to their previous level of mobility. During the application of the percutaneous cerclage wires, there were no vascular or nerve injuries and none of the patients returned with any wound complications.

Femoral head reduction osteoplasty for fracture dislocation: A surgical technique

BackgroundFemoral head fractures with subchondral impaction and cartilage loss are difficult to treat successfully. Although multiple surgical management options have been described, no one technique has proven superior, particularly in the young high-demand population. TechniqueA femoral head reduction osteoplasty was performed following a surgical dislocation of the hip. A peripherally based wedge of bone was resected off the damaged central third of the head followed by reduction and fixation of the remaining fragments. This technique resulted in a smaller yet congruent femoral head. MethodsA healthy 40-year old labourer sustained a traumatic crush injury while at work, resulting in a left femoral head fracture dislocation with an associated posterior wall acetabular fracture. Significant femoral head impaction and cartilage loss limited the treatment options. ResultsIntraoperative reduction and postoperative imaging demonstrated near anatomic reconstruction of femoral head with a congruent hip joint. Superiorly at the level of resection, the medial–lateral diameter was reduced by 5–6mm (approximately 12–15% the diameter of the original head) by the osteoplasty. At five years, Harris Hip Score was 86, Oxford Hip Score 36, and UCLA score 89. Hip abductor strength was full, range of motion near normal, and the patient ambulated without antalgia. Radiographs demonstrate a congruent joint and patchy avascular necrosis without collapse. The patient maintained full employment as a labourer. ConclusionsFemoral head reduction osteoplasty is a viable option that may produce durable intermediate-term results for complex femoral head fracture with superior impaction and chondral damage.Level of Evidence: Level V.

3D atlas-based registration can calculate malalignment of femoral shaft fractures in six degrees of freedom

Objective: This study presents and evaluates a semi-automated algorithm for quantifying malalignment in complex femoral shaft fractures from a single intraoperative cone-beam CT (CBCT) image of the fractured limb.Methods: CBCT images were acquired of complex comminuted diaphyseal fractures created in 9 cadaveric femora (27 cases). Scans were segmented using intensity-based thresholding, yielding image stacks of the proximal, distal and comminuted bone. Semi-deformable and rigid affine registrations to an intact femur atlas (synthetic or cadaveric-based) were performed to transform the distal fragment to its neutral alignment. Leg length was calculated from the volume of bone within the comminution fragment. The transformations were compared to the physical input malalignments.Results: Using the synthetic atlas, translations were within 1.71 ± 1.08 mm (medial/lateral) and 2.24 ± 2.11 mm (anterior/posterior). The varus/valgus, flexion/extension and periaxial rotation errors were 3.45 ± 2.6°, 1.86 ± 1.5° and 3.4 ± 2.0°, respectively. The cadaveric-based atlas yielded similar results in medial/lateral and anterior/posterior translation (1.73 ± 1.28 mm and 2.15 ± 2.13 mm, respectively). Varus/valgus, flexion/extension and periaxial rotation errors were 2.3 ± 1.3°, 2.0 ± 1.6° and 3.4 ± 2.0°, respectively. Leg length errors were 1.41 ± 1.01 mm (synthetic) and 1.26 ± 0.94 mm (cadaveric). The cadaveric model demonstrated a small improvement in flexion/extension and the synthetic atlas performed slightly faster (6 min 24 s ± 50 s versus 8 min 42 s ± 2 min 25 s).Conclusions: This atlas-based algorithm quantified malalignment in complex femoral shaft fractures within clinical tolerances from a single CBCT image of the fractured limb.

Role of Intramedullary Interlocking Nailing In Complex Femoral Shaft Fractures

Restoration of alignment, rotation and length, preservation of the blood supply to aid union and rehabilitation of the patient are the goals of treatment. The type and location of the fracture, degree of communition, the age of the patient, patients social, economic demands and other associated fractures may influence the method of treatment. Currently intramedullary, interlocking nailing is considered to be the treatment of choice for complex femoral shaft fractures. (Funk .J.Wells. R et al 1968.) 2 .

Computer-assisted navigation of a complex femoral shaft fracture: Instruction in three steps – A technical note

The procedure of computer-assisted navigation of femoral shaft fractures is well described. Nevertheless, its use is less common. An unclear disposal and longer operation times might be two reasons. The aim of this technical note is to render assistance concerning the ideal disposal of the setup.

Fibrous dysplasia, shepherd\'s crook deformity and an intra-capsular femoral neck fracture

Fibrous dysplasia (FD) is a rare bone disorder in which normal medullary bone is replaced by fibro-osseous tissue. It typically presents in childhood with pain, skeletal deformities, gait abnormalities and occasionally, fatigue fractures. The management of FD remains a challenge. Surgical procedures have been developed to provide symptom relief, correct skeletal deformity and offer mechanical support in cases at risk of fracture. However, there is a paucity of data on the management of acute femoral neck fractures in the adult population with FD. We report the case of a 23-year-old man with a shepherd’s crook deformity secondary to FD, who sustained an intra-capsular femoral neck fracture whilst playing football. The patient initially underwent closed reduction and internal fixation with cannulated screws. However, during the procedure, a guide wire broke whilst inside the femoral head. The patient was referred to the senior author, who undertook a second operation to remove the metalwork and correct the varus deformity using a closing-wedge femoral osteotomy, whilst achieving osteosynthesis at the fracture site. At 1-year follow-up, the patient is pain-free and demonstrates a full range of movement. These cases can be technically demanding and carry a greater risk of complication. It is important that preoperative planning is undertaken and surgery performed by individuals with experience in managing FD and complex femoral neck fractures. Correction of the skeletal deformity whilst fixing the fracture will help restore the mechanical axis and reduce the risk of a recurrent fracture.

English

BACKGROUND:-This study is to determine the clinical course and results after interlocking nailing for femoral shaft fractures , merits and demerits of interlocking nailing, achieving the final goals of femoral shaft fracture management with special references to time for radiological union, knee stiffness, limb length discrepancy, ambulation and return to work. Femur is the strongest and heaviest bone in the human skeleton. It is also the longest bone contributing 26% to height of an individual. Fractures of the shaft of the femur are among the most common fractures encountered in orthopaedic practice, can cause prolong morbidity and extensive disability unless treatment is appropriate. Many treatment modalities were described; with many surgeons advocating different methods of treatment .At present Interlocking nailing of the femur seems to be the ideal method of treatment for complex femoral fractures.

Clinical outcome and challenges of segmental-complex femoral fractures

Introduction: Aim of this study is to present the clinical profile and outcomeof complexmultifragmented/segmental femoral fractures, comparing their outcome following different management strategies. Materials and methods: Retrospective single centre cohort study of complex femoral fractures classified as AO types 32-C.1/2/3. Pathologic, paediatric fractures were excluded. Demographics, mechanism of injury, type of fracture, associated injuries (AIS05), ISS and NISS, treatment method, secondary procedures, complications and final clinical outcome were recorded. Descriptive statistical methods were utilised comparing early-total-care (ETC) protocols versus damage-control-orthopaedics (DCO). Results: 22-patients (24-fractures) were identified over a 4year period. Young males represented the majority (75%), with median age 32 years (18–71). Road-traffic-accidents were responsible for all of these injuries. Therewere 12 32-C.2 (segmental), and 12 32-C.3 (multifragmented) fractures (4 open grades 3A/B). The median length of the segment or, of the comminution was 13.1 cm (3.9–26.6).There was bone loss in 5cases (ranging 7.8–13.6 cm). Median ISS was 22 (9–41), median NISS was 27 (13–43). Half were managed according to ETC and half in stages (DCO). Deep local sepsis complicated 6 cases, 1 thromboembolism, 1 femoral head AVN, and 2 systemic complications. Three months post-injury mortality was 18%. The rest 9/19 fractures united after median period of 8 months (6–9). There were 2delayed-unions (healed at 11 and 12months) and 8 nonunions. Secondary interventions were necessary for 9 cases (6 healed, 3 still under treatment). DCO was associated with higher ISS/NISS, mortality, while the clinical outcome of either treatment protocol was comparable. Discussion: Severe femoral fractures represent an index injury of severe trauma, are associated with multiple other injuries. Their mortality, complication rate and final clinical outcome remain suboptimal irrespective of different management strategies.

Percutaneous cerclage wiring for reduction of periprosthetic and difficult femoral fractures. A technical note

BackgroundCombining closed reduction techniques with minimally invasive plate osteosynthesis (MIPO) or intramedullary nailing is a technically challenging procedure, especially when dealing with complex femoral fractures such as periprosthetic fractures. Cerclage wiring is a well known adjunct for fracture reduction and fixation. However, it is usually performed by open reduction, requiring wide surgical exposures, that results in soft tissue stripping. ObjectivesTo present how a novel cerclage wiring technique, employing a new percutaneous cerclage system, helped reduce a periprosthetic femoral fracture, fixed with MIPO, and a difficult proximal femoral fracture, stabilized with an intramedullary nail. ConclusionPercutaneous wiring is an alternative reduction technique to facilitate the reduction and maintenance of difficult femoral fractures, which reduces the radiation exposure to the surgeon.

Sequential reconstruction of complex femoral fractures with circular hybrid Sheffield frame in polytrauma patients

The timing of definitive fixation for major fractures in polytrauma patients is controversial. We investigated the outcome of the Sheffield hybrid system (SHF) as a solution in the role of primary and definitive fixator for patient with open femoral fractures in whom definitive osteosynthesis with intramedullary nail can be associated with higher rate of complications. Eleven patients (7 men and 4 women), mean age of 40.4 years (range 14-75 years) with previous injury severity score (ISS) greater than or equal to 16 were treated from a damage control orthopedics perspective. Time in the fixator averaged 28 weeks (range 10-64 weeks). Mean follow-up was 3 years (2-4.5). All fractures united. Paley functional and bone results in most cases were good to excellent. Final mean knee range of motion was 113 degrees. We found that SHF for complex fractures of the femur combine maximum support for the bone and preservation of soft tissues. SHF is an effective technique compared to internal nails and earlier external fixator devices, attributable to its advantages such as continuity of frame till union, preventing any second-hit phenomenon, early mobilization, and restoration of primary defect due to bone loss by differential distraction osteogenesis without additional surgery.