HOW MANY MULTIPLE TRAUMA PATIENTS BENEFIT FROM THE BIOMECHANICAL ADVANTAGE OF INTRAMEDULLARY NAILING OF FEMUR FRACTURES REGARDING EARLY WEIGHT-BEARING

The benefit of early operative stabilization of femoral fractures is e stablished in patients with multiple injuries. In the last few years t he unreamed femoral nail is favoured for internal fixation of femoral fractures despite pathophysiological concerns. The foremost advantage of femoral nails compared with plate fixation is the possibility of ea rly full weight bearing. The aim of this retrospective study was to in vestigate, under consideration of the severity of injury, the extent o f injury, and the clinical course, if multiple injured patients with c oncomitant femoral fractures benefit from the preferred intramedullary nailing with early weight bearing. Three hundred and two (23.8%) out of 1271 multiple injured patients (ISS > 17) had a concomitant femoral fracture. Fourty-seven out of 302 patients were children under 16 yea rs of age, remaining 255 patients. Eighteen out of 255 patients died w ithin the first 21 days after trauma and 66 patients required mechanic al ventilation for more than three week, (171/255). Thirty patients su ffered from severe head injury (AIS-head > 3) and seven from severe pu lmonary contusion with concomitant abdominal injury (134/255). Two pat ients had grade III open femoral fractures with vascular injury. Ipsil ateral unstable pelvic fratures were seen in 11 patients, seven patien ts had ipsilateral intraarticular femoral fractures, and ipsilateral i ntraarticular fractures of the lower leg or foot were observed in 40 p atients (74/255). The results demonstrate, that only 74 (29%) out of 2 55 multiple injured patiens ( > 16 years of age) had a theoretical ben efit of early weight bearing. Seventy percent of the patients did not benefit from intramedullary nailing considering full weight bearing. W ith regard to pathophysiological concerns alternative methods of fract ure fixation should be discussed for these patients. Primary fracture fixation with external fixators and secondary internal fixation proved to be a save alternative method. The complication rate of plating is comparable to intramedullary nailing but associated with less severe s ystemic risks. Primary plating of femoral fractures would not delay mo bilization of most multiple injured patients.