Fixation Technique For Treating Femoral Fractures In Adult Patients At Al-Noor Specialized Hospital: A Prospective Study

Abstract

The aim of the study is to evaluate the result of treatment of femoral shaft fractures in adult using external fixation. During the period from March 2020 to September 2023, eighteen adult with nineteen femoral shaft fractures treated with External Fixation (Ex. Fix.) were prospectively studied. The age of patients ranged from 14-65 years, with male: female ratio of 15: 3. The mechanism of injury was road traffic accident in all cases. There were six adult with multiple injuries (33%). Patients were received in emergency room where preliminary skin traction and Thomas splint were applied for few days, then under general anesthesia and on traction table under image intensifier, closed reduction was performed, shortening of 1-1.5cm was accepted but no rotational or angular deformity accepted. Ex. Fix. Was applied after draping using two pins inserted proximally and other two inserted distally and connected by two bars. Anteroposterior and lateral X-rays taken and dressing done. We used two systems of external fixation; I- Hoffman and II- Synthes (AO). The average time of operation was 30 minutes. The average follow up period was 22 months. During follow up Pin track infection, radiological and clinical union, malunion, overgrowth, shortening, and stiffness of adjacent joint were ascertained. All fractures united in 4-16 weeks then Ex. Fix. Was removed. Pin track infection grade III reported in 8 patients (42%), treated with daily dressings and oral or IV antibiotics. Overgrowth of 1 cm reported in 4 cases (21%), no patient developed shortening of the limb. Stiffness of the adjacent joint was reported in all patients and treated with physiotherapy, and full range of motion was regained. There were two refractures (10.5%) occurred through the previous fracture site after removal of the device treated with ORIF using DCP. No bone infection was seen. It is an excellent method for restoring the alignment without exposure of the fracture site and this helps fracture union. It is relatively quick operation with minimal blood loss. External fixation can be considered good option for children with multiple trauma or head injuries.