[Impaired Healing after Surgery for Femoral Fractures].

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Bone Healing Research

Background:

• Femoral fractures, especially in polytrauma patients, present significant challenges in bone healing.
• Damage control surgery with external fixators is often the initial management for severe injuries.

Purpose of the Study:

• To analyze the causes of impaired bone healing in femoral fractures.
• To present management options for complex femoral fractures.

Main Methods:

• Retrospective analysis of prospectively collected data (2008-2013) from high-energy trauma patients (ISS/NISS > 15).
• Evaluation of various osteosynthesis methods including unreamed femoral nails (UFN), distal femoral nails (DFN), plates, and proximal femoral nail antirotation (PFNA-long).

Main Results:

• Pseudarthrosis (non-union) occurred in 9.3% of femoral fractures (12/129).
• Distal femur fractures had a higher non-union rate (21.4%) compared to diaphyseal fractures (7.2%), particularly in open fractures.
• Proximal femur fractures demonstrated complete healing in all cases.

Conclusions:

• Non-union rates for diaphyseal fractures treated with UFN are consistent with existing literature.
• Higher non-union rates in distal femur fractures may be attributed to high-energy trauma and overall injury severity impacting biological healing potential.
• Optimal outcomes depend on understanding biomechanics, fracture morphology, and selecting appropriate fixation (e.g., narrow long nail for comminuted, thick short nail for transverse/oblique).