gms | German Medical Science

Deutscher Kongress für Orthopädie und Unfallchirurgie, 75. Jahrestagung der Deutschen Gesellschaft für Unfallchirurgie, 97. Tagung der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie, 52. Tagung des Berufsverbandes der Fachärzte für Orthopädie und Unfallchirurgie

25. - 28.10.2011, Berlin

Does the method of initial stabilisation for femoral shaft fractures have an impact on fracture healing?

Meeting Abstract

  • C. Garving - Universitätsklinik RWTH Aachen, Klinik für Orthopädie und Unfallchirurgie, Schwerpunkt Unfallchirurgie, Aachen, Germany
  • B. Nöldemann - RWTH Universitätsklinikum Aachen, Aachen, Germany
  • R. Pfeifer - Universitätsklinik RWTH Aachen, Klinik für Orthopädie und Unfallchirurgie, Schwerpunkt Unfallchirurgie, Aachen, Germany
  • C. Bley - Universitätsklinik RWTH Aachen, Klinik für Orthopädie und Unfallchirurgie, Schwerpunkt Unfallchirurgie, Aachen, Germany
  • P. Giannoudis - University of Leeds, Academic Department of Trauma & Orthopaedics, Leeds, United Kingdom
  • H.C. Pape - Universitätsklinik RWTH Aachen, Klinik für Orthopädie und Unfallchirurgie, Schwerpunkt Unfallchirurgie, Aachen, Germany

Deutscher Kongress für Orthopädie und Unfallchirurgie. 75. Jahrestagung der Deutschen Gesellschaft für Unfallchirurgie, 97. Tagung der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie, 52. Tagung des Berufsverbandes der Fachärzte für Orthopädie. Berlin, 25.-28.10.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocWI62-1226

DOI: 10.3205/11dkou391, URN: urn:nbn:de:0183-11dkou3918

Published: October 18, 2011

© 2011 Garving et al.
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Outline

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Questionnaire: The purpose of this study was to evaluate the time of bone healing in patients who underwent initial intramedullary nailing or external fixation compared with secondary definitive stabilisation.

Methods: Data were selected from the EPOFF (European Polytrauma Studygroup on the Management of Femoral Fractures) data base: Patients with femoral shaft fractures were randomized to initial (<24 hours) intramedullary nailing (I°IMN) or external fixation and later conversion to an intramedullary nail (I°ExFix). Inclusion: New Injury Severity Score (NISS) >16 points, or 3 fractures and Abbreviated Injury Scale (AIS) ≥2 points and another injury (AIS ≥2 points), age 18-65 years. For bone healing evaluation the patients x-rays (radiological healing) were now followed up 8, 12, 16, 24 and 48 weeks after initial treatment.

Results and Conclusions: 43 femur fractures in 40 multiple injured patients (mean age 27,5±8,6) were included. I°IMN (n=20, ISS=26); I°ExFix (n=23, ISS=22, definite stabilisation after 9,7±4,9 days), 3 patients suffered bilateral fractures. I°FixEx did not have a prolonged time of bone healing compared to I°IMN: After 8 weeks (I°IMN 34,8% vrs. I°FixEx 35%; p=0,431), after 12 weeks (69,6% I°IMN vrs. I°FixEx 65%; p=0,362), after 16 weeks (I°IMN 82,8% vrs. I°FixEx 70% p=0,210), 24 weeks (I°IMN 95,8% vrs. I°FixEx 90%; p=0,317), after 48 weeks (I°IMN and I°FixEx 100 % ; p=1).

DCO (Damage Control Orthopaedics) with initial external fixation is an easy procedure to access fractures in multiple injured patients. In addition we found that DCO is not associated with a delay in bone healing. So far we can assume this concept to be a safe strategy of primary fracture treatment.