Open fractures of the femoral shaft, treated with osteosynthesis or temporary external fixation

Controversy surrounds the treatment of open femoral shaft fractures, especially in the multiply injured. We report on 54 patients with 57 open femoral shaft fractures. They were treated according to our policy which deals with the severity of the soft-tissue damage. Low-grade open femoral fractures were primarily treated with internal fixation. A temporary external fixator was used for high-grade open fractures and in multiply injured patients where primary intramedullary nailing was contra-indicated. The external fixator was converted into an intramedullary nail as soon as the local soft-tissue disorders and the general condition of the patient permitted. There were no cases of deep infection. There was one case of malunion. Functional outcome was good to excellent in all cases. The aim of this paper is to show that low-grade open femoral fractures can be safely treated with primary intramedullary nailing and that temporary external fixation of severe open fractures followed by conversion into an intramedullary nail can be done without deep infection.