Is staged management with immediate conversion of external fixation to retrograde intramedullary nailing for combat-related Gustilo Type III supracondylar femur fractures safe and reliable method?

Abstract

Introduction: Femur fractures due to bomb explosions and gunshots in battlefield require osseous stabilization as quickly as possible to expedite emergent conditions. İmmediate external fixation is the initial procedure as usual with planned early conversion to definitive treatment. The purpose of the current study is to determine the results of the early retrograde intramedullary nailing in combat-related injuries.

Material and methods: Eighteen patients with comminuted supracondylar femur fractures, initially treated with external fixation followed by planned conversion to retrograde intramedullary nailing in a one-stage procedure, were evaluated in a retrospective review to gather demographic, injury, management, and fracture-healing data for analysis.

Results: According to the system of Gustilo Anderson and Orthopedic Trauma Association, all fractures were open type III and 33-A3, respectively. The mean follow-up, operation time and union time were 1.8 years (range, 6 months to 2,6 years), 75 min (range, 60-100), and 3 months (range, 1.5-4), respectively. There was one complication of acute osteomyelitis which was successfully treated with antibiotic-load beams and aggressive bone debridement. No septic arthritis was observed.

Conclusions: We concluded that immediate retrograde intramedullary nailing in combat-related supracondylar femur fractures regardless of contamination even in Gustilo type III is a safe and reliable treatment method.

Keywords: External fixation; Gustilo Type III; Retrograde intramedullary nailing; Supracondylar femur fractures.