Delayed internal fixation of femoral shaft fractures--is there an advantage? A review of 320 fractures.

We have reviewed 402 traumatic fractures of the femoral shaft, 320 of which had been treated by operation and had a long follow-up. Of these, 228 closed fractures and 37 open fractures had been stabilised by plating. There was no significant difference in healing between those stabilised early and those having delayed internal fixation. Re-fracture after removal of the implant occurred more often after early operation. All 55 fractures treated by intramedullary nailing healed and there were no re-fractures after nail removal. We found no correlation between delay before operation and the incidence of postoperative infection.

[Postoperative infection of fractures of the femoral diaphysis treated by osteosynthesis. Long-term outcome]. / L'infection post-opératoire des fractures de la diaphyse fémorale traitées par ostéosynthèse. Evolution à long terme.

The authors have operated on 284 simple fractures, complicated by 12 post-operative infections (4.2 per cent) and 43 compound fractures, complicated by four infections (9.3 per cent). All the fractures were treated by plating. Thirteen of the infected cases have received long-term follow-up - ten after simple fractures and three after compound fractures. Nine out of the ten cases following simple fractures have healed, eight retaining the plate until consolidation and two being considered as infected non-unions. One of these two healed secondarily after fresh fixation and the other is still draining after a second operation, but has united. Two out of the four cases following compound fractures have already healed. The two others were considered as infected non-union and healed after fresh fixation. It is concluded that infection after fracture of the femoral shaft is a serious complication, but healing can be obtained in almost all cases. No amputation was needed.