title: External fixator followed by a plate for distraction, reduction, and fixation in neglected femoral diaphyseal fractures.
abstract: BACKGROUND
  This study aims to investigate the outcome of a two-stage surgery in the treatment of neglected femoral diaphyseal fractures which are not uncommon in developing nations.
  
  
  METHODS
  Ten patients with neglected or late-presenting femoral diaphyseal fractures were considered in this study. All patients underwent a two-stage surgery, which consisted of distraction by an external fixator and open reduction by internal plate fixation. All patients received a supervised regimen of physiotherapy. Patients were followed up clinically and with radiographs at 2 months to assess union and at monthly intervals thereafter.
  
  
  RESULTS
  All patients achieved bony union in an average of 3.7 months (2-6 months) with no one lost follow-up. Seven patients regained full range of motion, and the mean knee range of motion was 139.5°. No wound related or neurovascular complications were detected. One patient with stiff knee was re-admitted 1 year after surgery for metal removal, arthrolysis and quadricepsplasty for improving knee range of motion to 90° flexion.
  
  
  CONCLUSIONS
  We conclude that the treating of neglected femoral diaphyseal fractures with a two-stage surgery is a satisfactory therapy showing reliable bony union, however continuing medical education is necessary for physicians in primary medical facilities as well as for patients with traditional views.
authors.affiliation: Institute of Orthopaedic Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, PR China.
authors.forename: Chongfei
authors.initials: C
authors.lastname: Yang
authors.forename: Huayi
authors.initials: H
authors.lastname: Wang
authors.forename: Qingsheng
authors.initials: Q
authors.lastname: Zhu
authors.forename: Jinyu
authors.initials: J
authors.lastname: Zhu
mesh_terms: D000328:Adult; D001860:Bone Plates; D018483:Diaphyses / Q000601:surgery*; D004502:Education, Medical, Continuing / Q000592:standards; D016267:External Fixators; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005593:Fracture Fixation, Internal; D017102:Fracture Healing / Q000502:physiology*; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010361:Patients / Q000523:psychology; D026741:Physical Therapy Modalities; D010820:Physicians; D016059:Range of Motion, Articular / Q000502:physiology; D016896:Treatment Outcome; D055815:Young Adult