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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 femurfractures, open and closed, with monolateral external fixation.

Since 1992 we started to use the monolateral external fixator on open fractures, as the initialmethod 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, notonly 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, trafficaccidents, 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.

Paralasf racturas abi e r t as,elpaciente esrecibido en la guardia yuna vezobtenidas lasradiografíasy estudios complementarios correspondientesesllevadoalquiróf anorealizandolatoi l e tte ycolocación del fijador externo.

Ejemplo:

Paciente de25 años confract u raexpuestade f émur, mediodiaf i s ariaoblicua larga,porheridade armade fuego, conlesiónvasculary neurológica.

Es llevadoa quirófano, toillette reparación neurovasculary colocaci

8/6/2019 Initial and Definite Treatment of Femur fractures with Monolateral External Fixation. Daniel Colletta, Osvaldo Corda…

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The closed fractures are initially treated with casts or braces, and then submitted to electivesurgery.

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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 rehabilitationcontinues, 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.