[Reconstructive measures in old gunshot fractures of the femur]

Gunshot fractures are open fractures of the third grade, and since they are usually of a complicated nature they present quite formidable problems. The article describes the cases of 9 patients with bullet wounds and the reconstructive surgery performed by the authors. Besides anatomical reconstruction of the femur, the main task was to achieve osteosynthesis which would remain stable even when exposed to exercise, usually together with an autologous bone chip implantation into the spongiosa. If the wound was already infected on admission to hospital, or if there was any other type of injury to the soft parts, the initial task was to achieve a satisfactory cure. Because of the high rate of complications, the infection had to be treated early by means of extensive revisions, debridements, sequestrotomies, through-drainages and the implantation of PMMA chains. In the course of treatment it became necessary to change the method of osteosynthesis several times. The results were impaired by repeatedly observed mobility restrictions in the region of the knee joints of the extremities involved, the severity of which depended on the period during which immobilization had been enforced before hospitalization.