title: Treatment of open proximal femoral fractures sustained in combat.
abstract: BACKGROUND
  Open proximal femoral fractures are rare injuries that often result from wartime high-energy causes. Limited data exist regarding the treatment and complications of these injuries.
  
  
  METHODS
  We retrospectively reviewed the records of combat casualties treated at two institutions between March 2003 and March 2008. The casualty patient databases, medical records, radiographs, and laboratory data were reviewed to determine time to union, complication rates, and patient outcomes.
  
  
  RESULTS
  Forty-one patients (thirty-nine men and two women) with a mean age of 25.7 years were identified as receiving treatment for open proximal femoral fractures. The mechanisms of injury for these forty-one patients were blast (twenty-nine patients [71%]), gunshot wound (eight patients [20%]), motor vehicle crash (three patients [7%]), and helicopter crash (one patient [2%]). There were thirty Type-IIIA, six Type-IIIB, and five Type-IIIC open fractures. The predominant method of definitive fixation was a cephalomedullary or reconstruction nail in thirty-four patients (83%). Thirty-nine patients had at least two years of follow-up data available for assessment of complications and radiographic union. The mean time to union was 5.1 months (range, 2.8 to 16.0 months). Complications requiring reoperation occurred in twenty-two (56%) of thirty-nine patients. Wound infection (twelve patients [31%]) and symptomatic heterotopic ossification (ten patients [26%]) were the most common complications.
  
  
  CONCLUSIONS
  Cephalomedullary nail fixation of open Type-III wartime subtrochanteric and pertrochanteric femoral fractures can be reliably used to effect fracture union in a timely manner. The most frequent complications of treatment are wound infection and symptomatic heterotopic ossification.
authors: Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA. amack2@caregroup.harvard.edu
authors: Andrew W
authors: AW
authors: Mack
authors: Brett A
authors: BA
authors: Freedman
authors: Adam T
authors: AT
authors: Groth
authors: Kevin L
authors: KL
authors: Kirk
authors: John J
authors: JJ
authors: Keeling
authors: Romney C
authors: RC
authors: Andersen
mesh_terms: D000328:Adult; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects*; D005597:Fractures, Open / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006620:Hip Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008889:Military Personnel; D009104:Multiple Trauma / Q000150:complications; D011183:Postoperative Complications; D011859:Radiography; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology; D016896:Treatment Outcome; D014481:United States