ACTA FAC MED NAISS 2009; 26 (3): 127-133

Original article

DAMAGE CONTROL STRATEGY IN THE TREATMENT OF CLOSED

FEMORAL SHAFT FRACTURES IN POLYTRAUMA PATIENTS

 

Predrag Stojiljković1, Zoran Golubović1, Desimir Mladenović1, Ivan Micić1, Saša Milenković1, Saša Karalejić1, Saša Stojanović1, Sonja Stamenić1 , Danilo Stojiljković2 , Milan Mandić3

1Clinic for Orthopaedic Surgery and Traumatology, Clinical Center Niš, Niš, Serbia

2Clinic for Plastic and Reconstructive Surgery, Clinical Center Niš, Niš, Serbia

3Clinic for Physical Medicine and Rehabilitation, Clinical Center Niš, Niš, Serbia

SUMMARY

Polytrauma is the leading cause of death in adults up to the age of 50 years. Proper management of closed femoral shaft fractures in polytrauma patients can greatly reduce mortality and morbidity. The prospective study followed and analyzed 68 polytrauma patients with 70 closed femoral shaft fractures, who were operatively treated in the Clinical Center Niš from June 1, 1999 to June 1, 2006. Worsening of the overall patients' condition following the external and internal fixation of the fractures pointed to statistically significant difference (χ2=16.40 p<0.001). Exacerbation of the condition of the polytrauma patients with femoral fractures was more frequently documented after internal fixation within initial 24 hours. External fixation of the fracture was followed by longer period of fracture healing, worse functional outcome and more frequent complications related to fracture management compared to the applied methods of internal fixation. The obtained results confirm the hypothesis that early internal fixation of the femoral fractures in the polytrauma patients poses great and additional trauma for the injured, and it can be safely performed after stabilizing the patient condition. External fixation stands for a safe operative method for accomplishing temporary stability of the femoral fracture in the polytraumatized patients and a minimally additional operative trauma. However, it is associated with a number of complications and a worse functional outcome when compared to the internal fixation method. External fixation of the femoral fracture in the polytraumatized patients should be converted into internal fixation when the patient's condition allows.

Key words: femoral shaft fractures, polytrauma, external fixation, internal fixation