INTRAMEDULLARY NAILING IN MULTIPLE INJURIES - PROS AND CONS OF ITS USE AS THE METHOD OF CHOICE

The progress after multiple trauma is influenced by the extent of the initial injury and the resulting inflammatory response as well as by t he severity of the thoracic trauma. Primary stabilisation of the femor al fracture is compulsory to ensure adequate intensive and respiratory care, e.g. changing between a supine and prone position. Intramedulla ry nailing in multiple trauma patients is still controversial. Because of retrospective studies concerning the time of operation in patients with multiple trauma of minor severity, primary intramedullary nailin g is the method of choice in the Angle-American section. In German-spe aking areas, however, differentiated management has been established b ecause of knowledge of the shock pathogenesis. Intramedullary nailing leads to an additive trauma in the sense of traumatic haemorrhagic sho ck. This is due to local pulmonary embolisation and systemic inflammat ory reactions. Therefore, in severe injuries (ISS>29 points) and/or se vere thoracic trauma (AIS>3), primary stabilisation by external fixati on should be preferred, whereas intramedullary nailing, especially the less risk unreamed nailing, is to be recommended in patients with min or injuries. Definite fracture healing should be achieved by a change to intramedullary nailing in a secondary operation.