Complications of Secondary Intramedullary Nailing Following Primary External Fixation of Femur Fractures: A Retrospective Analysis

Abstract

Background: Polytrauma patients with multiple long bone fractures risk haemorrhagic shock and fat embolism syndrome / acute respiratory distress syndrome. Damage control orthopaedics (DCO) addresses these risks in femoral fractures and is well established for patients with physiological compromise in trauma. Sparse literature is available for the management of open femur fractures in polytrauma whereby early nailing can lead to complications.
Method: Patients managed by DCO following femoral fractures at a public hospital, South Africa between the 1st of January 2007 to the 1st of August 2009 were analysed. All had significant open fractures, bilateral femur fractures or physiological compromise. Fracture details and associated soft tissue injuries were recorded. Medical notes and phone consultations provided information on demographics and management outcomes.
Results: 18 femurs were treated by DCO. 59% of the femur fractures healed with no complications. Four patients encountered major complications. One patient sustained non-union and proximal screw breakage. Two patients with bilateral femur fractures developed septic non-union; one of which developed bilateral septic non-union. One patient died from cerebral fat embolism which developed prior to fixation.
Conclusions: DCO is appropriate for managing polytrauma patients. The major complication was septic non-union attributable to the primary wound, pin site infections did not contribute to morbidity. Thorough initial wound debridement and earlier presentation would improve outcomes, early ExFix is crucial. This paper identifies the major hurdles when managing open femur fractures in polytrauma.

Keywords: external fixation, femur, intramedullary nail, polytrauma