The role of external fixation in the management of femoral shaft fractures is reviewed based on a study of 24 femoral fractures managed by either an A 0 or a Wagner external fixator during 1983–1986. Indications included open fractures with soft-tissue injury (13 patients), comminuted shaft fractures (six patients), and unstable operative candidates (five patients). In 14 patients, external fixation was a temporary method (Group I), while in ten patients it was the definitive method of stabilization (Group 11). Twenty-one patients achieved solid union, two developed a delayed union, and one had a nonunion. Three patients developed pin-tract infections, and one developed osteomyelitis after intramedullary fixation in Group I. Two patients in Group II developed shortening (2.1 cm and 3.2 cm). Loss of motion occurred in 11 patients, averaging 56″. It is suggested that external fixation be considered in the following types of femoral fractures: open fractures for aggressive management of soft-tissue injuries; closed fractures in severely traumatized, burn, or head injury patients; fractures about the knee resulting in floating knees; and infected femoral nonunions and pseudarthroses.
*From the University of Alabama at Birmingham.
**From the University of Mississippi Medical Center, Jackson, Mississippi.
Reprint requests to Jorge Alonso, M.D., 619 S. 19th Street, University of Alabama, Birmingham, AL 35233.
June 13, 1988.