External fixation in severe open tibial shaft fractures: indications, orthoplastic strategy, and infection-aware decision-making.

Complex fractures of the femoral shaft rise problems due to high energy trauma with major soft-tissues injuries and bone comminution so increasing operative difficulties, risk of infection and delayed union. Our aim was to appraise the outcome of these problems when using a closed intramedullary locked nailing. There were 52 men and 16 women. Aged 16 to 83 years. 52 patients had multiple-injuries. There were 17 open fractures. The 68 cases were subdivided according to a classification in 3 types. Stable fractures type A and B1 were excluded. The shaft was divided into 5 zones. Patients were initially treated by skeletal traction closed nailing was performed 1-36 days later (average 9.5). All patients were reviewed until complete healing. Final follow-up was 6 to 35 months postoperatively (average 15). A dynamisation was performed in 19 cases at a average delay of 12 weeks. Sixty six of the 68 fractures united. Open fractures united after 26.4 weeks, in average and closed fractures after 23.25 weeks (p < .05). There was no correlation between time of surgery following the injury and the delay of healing. Shortening was noted in 4 cases. 8 patients had an angulation 5-15 degrees of in the varus or the valgus plane. 3 patients (4.4 per cent) had more than 5 degrees of angulation in the AP plane. An external rotation deformity of 10-35 degrees was noted in 4 patients. The incidence of deformities was the main problem. It could be minimize by a precise technique. Mobility of the knee was the other problem, but it appeared generally to depend much more on knee injury than on femoral fracture.