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Intramedullary nailing after external fixation of the femur and tibia: a review of advantages and limits

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose and methods

External fixation is a safe option for stabilisation of extremity lesions in the polytraumatised patient as well as in fractures with severe soft tissue damage. Nevertheless, long-term-complications are to be expected when external fixation is chosen as a definitive treatment. The purpose of this review article is twofold: primarily, to define the rationale of a procedural change from an external fixator to an intramedullary nail; secondarily, to assess the possible advantages and pitfalls of a single- or two-staged procedure.

Results and conclusions

External fixation of the femur is recommended in multiply injured patients who are critically ill to avoid an additional inflammatory response caused by the surgical trauma of primary nailing. The conversion towards nailing must be done as soon as the clinical condition of the patient has been stabilised. Stable polytraumatised patients do not benefit from initial stabilisation with an external fixator and should immediately be treated with a definitive osteosynthesis. In tibial fractures, external fixation followed by intramedullary nailing is recommendable in fractures with severe soft tissue injuries. Conversion should be done as soon as the soft tissues allow before pin-tract infections occur and performed in a one-staged procedure.

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Conflict of interest

Philip Pairon, Christian Ossendorf, Sebastian Kuhn, Alexander Hofmann und Pol Rommens declare that they have no conflict of interest.

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  1. Department of Orthopaedics and Traumatology, University Medical Center of the Johannes Gutenberg-University, Langenbeckstrasse 1, 55131, Mainz, Germany

    P. Pairon, C. Ossendorf, S. Kuhn, A. Hofmann & P. M. Rommens

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Pairon, P., Ossendorf, C., Kuhn, S. et al. Intramedullary nailing after external fixation of the femur and tibia: a review of advantages and limits. Eur J Trauma Emerg Surg 41, 25–38 (2015). https://doi.org/10.1007/s00068-014-0448-x

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