EARLY EXCHANGE INTRAMEDULLARY NAILING OF DISTAL FEMORAL FRACTURES WITH VASCULAR INJURY INITIALLY STABILIZED WITH EXTERNAL FIXATION

Fracture of the femur with accompanying arterial injury represents app roximately 1% of all femoral fractures. Controversy exists regarding t he choice of fixation and the sequence of fixation and vascular repair . We report on the treatment of six patients with seven distal femoral fractures and angiographically documented arterial injuries treated o ver a 20-month period. The treatment protocol consisted of angiography followed by provisional external fixation and early primary exchange to an intramedullary nail. Five of the seven fractures were open. Thre e fractures were caused by blunt trauma, and four were secondary to sh otgun blasts. Average follow-up was 12 months (range, 6-25 months). Al l fractures healed with an average time to union of 25 weeks. There we re no complications related to the vascular repair. One case of an acu te deep infection resolved after debridement and placement of polymeth ylmethacrylate cement beads impregnated with antibiotics and a course of intravenous antibiotics. All patients returned to their previous le vels of activity. Based on the results of our experience with a small group of patients, we feel that this treatment protocol will prove to be a safe and efficient method of management of these difficult injuri es.