[Intramedullary nailing in multiple trauma]

The indication and best time for intramedullary nailing of long bones in the multiple trauma patient is still controversial. While in the Anglo-American literature primary intramedullary nailing is regarded as the method of choice, differentiated management is preferred in German-speaking countries on account of reports about the pathogenesis of trauma shock. On the one hand, it has been shown that severe thoracic injury greatly influences the course after multiple trauma and, in particular, its combination with femoral fracture represents an increased risk. On the other hand, every surgical intervention represents an additional trauma for the patient. Intramedullary reamed nailing of femur fractures represents considerable trauma, whereas unreamed intramedullary nailing of the femur or intramedullary stabilization of the tibia or humerus causes (in descending order) fewer changes. For early respiratory care (e.g., changing between the prone and supine position), however, primary stabilization of long bones is required. External fixation of the femur appears to be the method of choice for the severely injured patient. Definite fracture healing can be achieved by a change to intramedullary nailing in a secondary operation.