PRIMARY REAMED INTRAMEDULLARY NAILING OF OPEN FEMORAL-SHAFT FRACTURES

Forty-two patients with acute open femoral shaft fractures were assign ed prospectively to primary immediate or delayed reamed intramedullary stabilization, There were 27 primary and 15 delayed intramedullary na ilings performed (mean followup, 20 months), Twelve patients (29%) had Gustilo and Anderson Grade I injury; 16 (38%), Grade II; and 14 (33%) , Grade III (including 3 Grade IIIC), Average time to union was 3.8 mo nths, The infection and nonunion rate was 2.4%, Comparison of the 2 gr oups showed no significant differences in the incidence of infection, malunion, nonunion, or time to union, The data suggest that primary re amed intramedullary nailing is an effective treatment alternative for the patient with multiple injuries, regardless of soft tissue injury, including Grade III wounds, Isolated open femoral shaft fractures with Grade I and Grade II soft tissue wounds may be stabilized safely prim arily with no increased morbidity. Although results were promising, co ntinued study is needed to delineate the optimum management of all Gra de III injuries.