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Does the method of initial stabilisation for femoral shaft fractures have an impact on fracture healing?
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Veröffentlicht: | 18. Oktober 2011 |
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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.