A comparison of external fixation and locked intramedullary nailing in the treatment of femoral diaphysis fractures from gunshot injuries

  • G. PolatEmail author
  • H. İ. Balci
  • O. N. Ergin
  • A. Asma
  • C. Şen
  • Ö. Kiliçoğlu
Original Article



We studied the safety and incidence of complications from the treatment of gunshot-induced femur diaphysis fractures with locked intramedullary nailing in comparison to external fixation.


Patients who had femoral diaphysis fracture operations due to gunshot injuries (107 femurs of 99 patients) between 2003 and 2014 were retrospectively reviewed, and 66 femurs of 60 patients were place into two groups (Group A: intramedullary nailing—38 femurs of the 36 patients; Group B: external fixator—28 femurs of 24 patients). The mean follow-up was 76.3 months (22–131). The study outcomes were patient complications, infection rate, union time, need for secondary surgery, functional assessment with lower extremity functional scale, and radiological evaluation with orthoroentgenograms.


The mean age of the patients was 37.3 ± 7.4 years in Group A and 39 ± 6.1 years in Group B. There was no significant difference between the two groups in age, gender or follow-up. There were two deep infections (5.2%) in Group A and one deep infection (3.5%) in Group B. Delayed union was observed in four patients (10.5%) in Group A and in two patients (7.1%) in Group B. There was one non-union (2.6%) and one non-union (3.5%) in Group A and Group B, respectively. There was no significant difference between the two groups in incidence of union, delayed union or deep infection. The mean union time was 3.1 ± 2.5 months in Group A and 5.8 ± 1.4 months in Group B. The union time was significantly lower in the intramedullary nailing group (p = 0.023). There were no significant differences between the two groups in regards to radiological and functional evaluation.


This study showed similar complication rates and functional results both for external fixator and intramedullary nailing for the treatment of femoral diaphysis fractures due to gunshot injuries.

Level of evidence

Level 3 retrospective comparative clinical study.


External fixator Civilian gunshot injury Intramedullary nailing Complication Open femur fracture 



There is no funding source for our research. We did this research with our own funding. An informed consent form concerning the study to be performed was signed by all patients, and the institutional review board (16.02.2016, Istanbul University, IU-2016/153) approved this study.

Compliance with Ethical Standards

Conflict of interest

We hereby submit a manuscript entitled “A Comparison of External Fixation and Locked Intramedullary Nailing in the Treatment of Femoral Diaphysis Fractures from Gunshot Injuries” by Polat G, Balci HI, Ergin ON, Asma A, Sen C, Kilicoglu O to be considered for publication in European Journal of Trauma and Emergency Surgery (EJOT). We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome. The manuscript has been read and approved by all named authors who believe that the manuscript represents honest work. Polat G, Balci HI, Ergin ON, Asma A, Sen C, Kilicoglu O. declare that they have no conflict of interest.

Ethical approval

The study has been approved by institutional review board and ethics committee, and has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.


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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • G. Polat
    • 1
    Email author
  • H. İ. Balci
    • 1
  • O. N. Ergin
    • 1
  • A. Asma
    • 1
  • C. Şen
    • 1
  • Ö. Kiliçoğlu
    • 1
  1. 1.Department of Orthopaedics and Traumatology, Istanbul Medical FacultyIstanbul UniversityIstanbulTurkey

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