Intramedullary nailing after external fixation of the femur and tibia: a review of advantages and limits

Eur J Trauma Emerg Surg. 2015 Feb;41(1):25-38. doi: 10.1007/s00068-014-0448-x. Epub 2014 Sep 25.

Abstract

Purpose and methods: External fixation is a safe option for stabilisation of extremity lesions in the polytraumatised patient as well as in fractures with severe soft tissue damage. Nevertheless, long-term-complications are to be expected when external fixation is chosen as a definitive treatment. The purpose of this review article is twofold: primarily, to define the rationale of a procedural change from an external fixator to an intramedullary nail; secondarily, to assess the possible advantages and pitfalls of a single- or two-staged procedure.

Results and conclusions: External fixation of the femur is recommended in multiply injured patients who are critically ill to avoid an additional inflammatory response caused by the surgical trauma of primary nailing. The conversion towards nailing must be done as soon as the clinical condition of the patient has been stabilised. Stable polytraumatised patients do not benefit from initial stabilisation with an external fixator and should immediately be treated with a definitive osteosynthesis. In tibial fractures, external fixation followed by intramedullary nailing is recommendable in fractures with severe soft tissue injuries. Conversion should be done as soon as the soft tissues allow before pin-tract infections occur and performed in a one-staged procedure.

Publication types

  • Review

MeSH terms

  • External Fixators*
  • Femoral Fractures / diagnostic imaging
  • Femoral Fractures / pathology
  • Femoral Fractures / surgery*
  • Fracture Fixation, Intramedullary
  • Fracture Healing
  • Humans
  • Multiple Trauma / diagnostic imaging
  • Multiple Trauma / pathology
  • Multiple Trauma / surgery*
  • Postoperative Complications / microbiology
  • Postoperative Complications / pathology
  • Postoperative Complications / surgery*
  • Radiography
  • Soft Tissue Injuries / complications
  • Soft Tissue Injuries / pathology
  • Soft Tissue Injuries / surgery*
  • Surgical Wound Infection / microbiology
  • Surgical Wound Infection / pathology
  • Surgical Wound Infection / prevention & control*
  • Tibial Fractures / diagnostic imaging
  • Tibial Fractures / pathology
  • Tibial Fractures / surgery*