[Effect of femur stabilization in course of polytrauma in craniocerebral trauma]

A retrospective study of 40 patients with polytrauma classed according to the Hannover polytrauma score (PTS) as II and III including a brain injury and a femur fracture underwent a retrospective study. Patients who died early of brain injury were excluded. In 6 of 18 patients with PTS III, and 5 of 22 with PTS II, death supervened after more than 1 week, in most cases of pulmonary complications. Patients with PTS II needed artificial ventilation for an average of 7.7 days, and those with PTS III of 11.4 days. In 18 patients an immediate femur fixation was performed, in 7 patients a secondary (from the 2nd to 7th day), and 7 in patients a tertiary (after the 7th day) femur fixations, 8 patients required no operative femur fixation. In most cases internal fixation with plates (n = 24) was performed, while medullary nails and fixateurs externes were used in 4 cases each. Patients with secondary operative femur fixation had a worse outcome than patients with primary or tertiary operation: they lethality and the rate of pulmonary complications were higher, and artificial ventilation was more often needed. This difference was significant especially in the PTS II group, and is also seen between patients in whom the same operative procedure (plate osteosynthesis) was implemented. Medullary nailing led to a worse, and use of the fixateur externe to a better general outcome. On the other hand, patients subjected to secondary operations had no wound infections, as against 3 cases of wound infections following primary operations (including 7 on open fractures) and 1 following tertiary operations.(ABSTRACT TRUNCATED AT 250 WORDS)