INTRAMEDULLARY NAILING IN PATIENTS WITH M ULTIPLE INJURIES

The indication and best time for intramedullary nailing of long bones in the multiple trauma patient is still controversial. While in the An gle-American literature primary intramedullary nailing is regarded as the method of choice, differentiated management is preferred in German -speaking countries on account of reports about the pathogenesis of tr auma shock. On the one hand, it has been shown that severe thoracic in jury greatly influences the course after multiple trauma and, in parti cular, its combination with femoral fracture represents an increased r isk. On the other hand, every surgical intervention represents an addi tional trauma for the patient. Intramedullary reamed nailing of femur fractures represents considerable trauma, whereas unreamed intramedull ary nailing of the femur or intramedullary stabilization of the tibia or humerus causes (in descending order) fewer changes. For early respi ratory care (e.g., changing between the prone and supine position), ho wever, primary stabilization of long bones is required. External fixat ion of the femur appears to be the method of choice for the severely i njured patient, Definite fracture healing can be achieved by a change to intramedullary nailing in a secondary operation.