EXTERNAL FIXATION OF OPEN FEMORAL-SHAFT FRACTURES

Objective: To determine whether external fixation proves to be a sensi ble technique for definitive stabilization in open femoral fractures. Design: Retrospective clinical study. Materials and Methods: From 1985 to 1989, 18 patients (mean ISS 25.4) with open femoral fractures (typ e II 11%, type III 89%) were treated by primary and definitive externa l fixation. After failure of closed reduction procedures, open reducti on via debrided soft tissue wounds was employed in 72%. Supplemental i nternal fixation of large wedge fragments was required in 66%. Externa l fixators were removed after a mean of 166 days. Early deep infection s developed in 11%. Additional cast, brace, or traction were not requi red. Measurements and Main Results: After a mean follow-up period of 5 8 months, 88% of the surviving 17 patients were clincally and radiolog ically evaluated and 12% were interviewed by telephone. Eleven percent developed late deep infection of the femur concerned, Eighty percent have had full or slightly restricted knee motion. The mean knee flexio n amounted to 130 degrees. Relevant shortening of the femur was diagno sed in 7%. Nonunions or relevant malunions were not observed in our se ries. Conclusions: These morphologic and functional results compare wi th those published for alternative stabilization techniques of femoral fractures. For special indications, external fixation is considered t o be a sensible technique for primary and definitive treatment of open femoral fractures.