title: Alternative fixation method for open femoral fractures from a damage control orthopaedics perspective.
abstract: A decision for immediate versus delayed fixation in a polytrauma patient mainly in cases of open femoral fracture depends upon time elapsed since injury, duration of stay in intensive care, soft tissue status, probable intra-operative difficulties and presence of systemic complication. We studied the outcome of the Taylor Spatial Frame (TSF) as a solution in the role of primary and definitive fixator for patients in whom definitive osteosynthesis with intramedullary nailing (IMN) can be associated with higher rate of complications. In view of damage control orthopaedics (DCO), we found that TSF is an effective technique compared to internal nails and earlier external fixator devices, attributable to its advantages such as continuity of frame till union, preventing any second-hit phenomenon, early mobilisation and restoration of primary defect due to bone loss by differential distraction osteogenesis without additional surgery. According to the Paley and Maar's evaluation criteria, 11 patients had an excellent result with clinical and radiological union; the functional result was excellent in three patients, good in five, fair in two and poor in one.
authors.affiliation: Department of Orthopedic Surgery and Traumatology, Niguarda Hospital, Paolo Giovio 45, 20144 Milan, Italy. sala.francesco@gmail.com
authors.forename: Francesco
authors.initials: F
authors.lastname: Sala
authors.forename: Dario
authors.initials: D
authors.lastname: Capitani
authors.forename: Fabio
authors.initials: F
authors.lastname: Castelli
authors.forename: Giovanni Andrea
authors.initials: GA
authors.lastname: La Maida
authors.forename: Giovanni
authors.initials: G
authors.lastname: Lovisetti
authors.forename: Saurabh
authors.initials: S
authors.lastname: Singh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003422:Critical Care; D016267:External Fixators / Q000592:standards*; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D005592:Fracture Fixation / Q000295:instrumentation / Q000379:methods*; D005597:Fractures, Open / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000601:surgery*; D010043:Outcome and Process Assessment, Health Care; D011859:Radiography; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult