[Fixation of femoral shaft fractures from a Swiss viewpoint. An international prospective controlled study by the Study Group for Osteosynthesis Problems].
A prospective, controlled study of fixation for femoral shaft fractures was undertaken by the Documentation Centre of the Association for the Study of Internal Fixation (AO/ASIF) at 7 Swiss and 5 foreign clinics in Europe, South America and Asia. 283 fractures in 272 patients were evaluated. 17% of all patients suffered a polytrauma. Only two fractures (1%) were treated conservatively. Ten percent of all fractures were stabilised by external fixation, 35% were plated and 54% were treated by reamed intramedullary nailing. An ARDS and deep venous thrombosis occurred in 1% respectively. The local infection rate was 2%. Seven patients (2.5%) died perioperatively. 32 fractures (12%) were reoperated. At follow-up 86% of all fractures appeared consolidated on radiography. Full limb function was restored in 61% of all patients, slight impairment persisted in 32% and 6% of all patients remained severely handicapped. The average age of the female patients was significantly higher in Europe. Wide differences existed in the administration of prophylactic antibiotics and antithrombotic drugs. In some centers antithrombotic drugs were not part of the treatment scheme. Femoral shaft fractures were treated with high priority in Switzerland. Patients profited from short transport ways and from the routine use of high end material. Most operations in Switzerland were performed by registrars. Their assessment of stability of the fixation was high, as 90% of all patients were allowed to bear weight postoperatively. There is an international consensus on the need for surgical stabilisation of femoral shaft fractures. However divergent views on surgical management and perioperative care remain.
Weber
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AO-Dokumentationszentrale, Davos Platz.
Matter
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D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D016267:External Fixators; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000379:methods*; D005594:Fracture Fixation, Intramedullary; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D016459:Prosthesis-Related Infections; D016896:Treatment Outcome