Initial and Definite Treatment of Femur fractures with Monolateral External Fixation

Daniel Colletta, Osvaldo Cordano, Alberto Vaccarelli, Claudio Guerreiro

Hospital Municipal Dr. Eduardo Wilde, Acvellaneda, Buenos Aires, Argentina

In this paper we present our experience regarding the initial and definite treatment of femur
fractures, open and closed, with monolateral external fixation.
Since 1992 we started to use the monolateral external fixator on open fractures, as the initial
method to stabilize the fracture site, and allowing us to treat accompanying wounds. Due to the delay of
the osteosynthesis hardware requested, we studied the possibility of improving the initial fixation, not
only to stabilize the fracture, but also aiming to achieve an anatomic reduction, avoiding angulation,
rotation and shortening.
Soon, for the same reason of delayed delivering of the hardware, we started to use the fixators on
closed fractures, with promising results.
It’s now the place to mention that our hospital works with a Traumatology Investigation Centre,
where a system of hinged monolateral fixation was developed, and is being used for the treatments
described above.
As indications, all femur fractures were included, open or closed, independently of the fracture
line.
We treated a total of 84 fractures, 33 closed and 51 open. The causes were gunshot wounds, traffic
accidents, sports accidents, fall from heights, etc.
Open fractures were managed immediately at the operating room for toilette and external fixation,
after the initial approach at the emergency room, for x-ray and blood work.

Example:
25 years old patient with open fracture of the femur, oblique medial diaphysis, caused by gunshot
wound, with neurovascular lesion. He was taken to the operating room, for toilette, neurovascular
reconstruction and external fixation.

Par a l as fr act ur as ab
i er t as , el paci en
t e es r eci bi doen la guar d
i a yuna vez obt en
i das l as r adi ogr af í as y es t udi os com plem entari os corr es pondi entes es l l evadoal qui r ófa no r eal i zandol at iol ett e ycol ocaci ón del f i j ador exter no.
Ej em pl o:

Paci ent e de 25 año s conf r act ur a expues t ade fé m ur, m edi odi af i s ar i aobl ic ua la r ga, por her i da de ar m ade f uego, conl es i ón vas cul ar y neurol ógi ca.
Es l l evadoa qui r óf ano
, t oi l ett er epar aci ón neur ovasc ul ar y co
l ocaci
 The closed fractures are initially treated with casts or braces, and then submitted to elective
surgery.
 During the postoperative period, the corresponding dressings are concerned and immediate kinetic
treatment takes place, moving the proximal joints. By the first 24 hours the patient can sit up, and at 48
hours he can walk with crutches and supervision.
The follow-up includes clinical and radiological control, weekly at first, then every three weeks.
Two weeks before the fixator removal we start to dynamize. After bone healing, the rehabilitation
continues, up to the full joint motion.
We’ve obtained promising results with this method.
Of the 51 open fractures, 11 were trauma patients with poor heath condition and elderly patients,
ASA III IV, submitted to local anaesthesia.
We observed the usual complications: pin infection, pin osteolysis, cellulitis, post-traumatic lost of
anatomical reduction, lost of RAM.
There was no need for hardware removal, or the use of other type of hardware.
In cases of delayed union we compress the fracture site to prevent seudoartrosis.
In our experience we conclude that the correct initial positioning of the external fixator is now a
definite method of treatment for open fractures, showing no need for a second method of osteosynthesis,
and therefore avoiding a second surgical intervention.
Regarding closed fractures we use the external fixator as an alternative method, in order to
preserve the biology of the callus formation.