Early complications in the management of open femur fractures: a retrospective study

Fifty patients with 53 open fractures of the femur were reviewed retrospectively. There were three subtrochanteric, 32 shaft, and 18 supraintercondylar fractures. Eleven were type I open fractures, 20 were type II open fractures, and 22 were type III open fractures. After initial debridement, 33 fractures had immediate internal fixation, nine had delayed internal fixation, one had external fixation, and 10 were treated with traction and cast bracing. Nine (16%) fractures, two type II and seven type III, developed deep infection. Five infections persisted at 6 months. Immediate internal fixation was followed by deep infection in one of 22 type I or II fractures and six of 11 type III fractures. There were five nonunions and seven delayed unions. Five of 44 uninfected and seven of 10 infected fractures had delayed union or nonunion. In this series, most patients with type III open femur fractures had severe associated multiple trauma. Immediate internal fixation was associated with greater local complications. We have concluded that immediate internal fixation of type III femoral fractures is only relatively indicated and must be applied with caution.