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Year |
2002 |
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Question Number |
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Category |
Musculoskeletal Trauma |
Question
A 30-year-old patient sustains an isolated type II open femoral shaft fracture. In addition to irrigation and debridement, management should include
1- Skeletal traction.
2- Unlocked unreamed intramedullary nailing.
3- Locked reamed intramedullary nailing.
4- External fixation.
5- Open reduction and internal fixation with a plate and screws.
Figures
Answer (click for answer)
Correct Answer: 3- locked reamed intramedullary nailing.
While all of the above are acceptable options, clearly IM nailing has evolved as the best treatment for the majority of femoral shaft fractures. Brumback et. al. extended this treatment to include open fractures. They studied retrospectively eighty-nine cases in which open femoral shaft fractures were treated with locked reamed intramedullary nailing. Part of their criteria for immediate IM nailing was that irrigation and debridement were performed within eight hours after injury. All fractures healed in an average of 5.2 months. No infections occurred in their grade I, II, and IIIA open fractures. Three infections occurred in their twenty-seven grade IIIB cases. They concluded that immediate locked reamed IM nailing, within an eight hour window from injury, was appropriate treatment for grade I, II, and selected III femoral shaft fractures.
Reference: J Bone Joint Surg Am 1989;71:1324-1331.