[Femur osteosynthesis in the polytrauma patient--considerations for reasonable surgery time frame from the viewpoint of military service medical treatment].

OBJECT: What are the concepts of secondary osteosynthesis in polytrauma patients? What are indicators underlying these concepts? Are there consequences for Military Medicine?

RESULTS

Conservative stabilization techniques are unsuitable. The intramedullary nail is considered to be large-scaled and technically demanding. It leads to additional stress for the patient (second hit). The following parameters are not suitable: General status, soft-tissue condition, lung fluid, thrombocytes, PNM elastase, cathepsine, lactate, CRP, neopterin, AT III, t-PA-inhibitor, PFI-index, bilirubin.

CONCLUSIONS

An objective parameter for the choice of the proper timing of definitive fracture treatment does not exist. In the literature, only few parameters are enumerated. Inconsistent recommendations are hardly discussed. Therefore, from the viewpoint of Military Medicine, we recommend external fixation for primary stabilization. Finally, the systemic inflammatory response has eased off after 5-7 days. Then the definitive operative procedure--intramedullary nailing--should be planned.