The Impact of External Fixation of Femoral Fractures on Mortality and Morbidity in Polytrauma Patients

  • E. Brug
  • S. Winckler
  • M. Püllen
  • W. Klein


In the late 1970s it was generally accepted that the patient with multiple injuries was too ill to undergo surgical stabilization of a long bone fracture in the period prior to admission to the Intensive Care Unit. Priority in the resuscitation phase was given almost exclusively to ensuring that respiratory and cardiovascular function was restored and maintained, by intubation and fluid replacement. An exception to this rule was the emergency treatment of uncontrollable massive bleeding from large vessels in the extremities, which if ignored, would render useless any concomitant treatment for shock.


Femoral Fracture External Fixation Adult Respiratory Distress Syndrome Surgical Stabilization Lung Complication 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Wolff G, Dittmann M, Frede KE. ‘Klinische Versorgung des Polytraumatisierten’.Chirurg 1978; 49: 737–44.PubMedGoogle Scholar
  2. 2.
    Brug E. ‘Dringlichkeit der Versorgung von Extremitätenverletzungen beim Polytrauma’. in: Peter K, Lawin P, Jesch F (Hrsg): Der polytraumatisieret Patient. Thieme: Stuttgart, New York, 1982. Google Scholar
  3. 3.
    Brug E, Klein W, Grünert. ‘Die Behandlung der offnen Frakturen mit dem Fixateur externe - unter Berücksichtigung der dynamisch-axialen Fixation ‘Orthofix’’. Der Chirurg 1987; 58: 699–705. Google Scholar
  4. 4.
    Hutchins PM, Macnicol MF. ‘Pulmonary Insufficiency After Long Bone Fractures’. J Bone Joint Surg [Br] 1985; 76B: 835. Google Scholar
  5. 5.
    Allardyce DB, Meek RN, Woodruff B, Cassim MM, Ellis D. ‘Increasing our knowledge of the pathogenesis of fat embolism; a prospective study of 43 patients with fractured femoral shafts’. J Trauma 1974; 14: 955–62.PubMedCrossRefGoogle Scholar
  6. 6.
    Riska EB, von Bonsdorff H, Häkkinen S, Jaroma H, Kiviluoto O, Paavilainen T. ‘Primary Operative Fixation of Long Bone Fractures in Patients with Multiple Injuries’. J Trauma 1977; 17: 111–21.PubMedCrossRefGoogle Scholar
  7. 7.
    Goris RJA, Gimbrere JSF, van Niekerk JLM, Schoots FJ, Booy LHD et al ‘Early Osteosynthesis and Prophylactic Mechanical Ventiliation in the Multitrauma Patient’. J Trauma, 1982; 22: 895–903.PubMedCrossRefGoogle Scholar
  8. 8.
    Seible R, LaDuca J, Hassett JM, Babikian G, Mills B, Border DO, Border JR. ‘Blunt Multiple Trauma (ISS 36), Femur Traction and the Pulmonary Failure Septic State (PFSS)’. Ann Surg 1985; 202: 283–93.CrossRefGoogle Scholar
  9. 9.
    Johnson K, Cadambi A, Seibert GB. ‘Incidence of Adult Respiratory Distress Syndrome in Patients with Multiple Musculoskeletal Injuries: Effect of Early Operative Stabilization of Fractures’. J Trauma 1985; 25: 375–84.PubMedCrossRefGoogle Scholar
  10. 10.
    De Bastiani G, Aldegheri R, Renzi-Brivio L. ‘The Treatment of Fractures with a Dynamic Axial Fixator’. J Bone Joint Surg [Br] 1984; 66B: 538–45.Google Scholar
  11. 11.
    Brug E, Pennig D, Gähler R, Haeske-Seeberg H. ‘Polytrauma und Femurfraktur’. Akt Traumatol 1988; 18: 930–4.Google Scholar
  12. 12.
    Winckler S, Brug E. ‘Der Stellenwert der Femurfraktur beim Polytrauma’. in: Die dynamisch-axiale externe Fixation; Neumann H-S, Klein W, Brug E (Hrsg). Hans Marseille Verlag GmbH: München 1993. Google Scholar
  13. 13.
    Broekhuizen AH, Boxma H, Meulen van der PA, Snijder CJ. ‘Performance of external fixation devices in femoral fractures; the ultimate challenge? A laboratory study with plastic rods’. Injury 1990; 21: 145–51.PubMedCrossRefGoogle Scholar
  14. 14.
    Broekhuizen AH. The stability of external fixation systems for the treatment of femoral fractures — a comparative evaluation. This book, Ch. 7.Google Scholar
  15. 15.
    Pape H-C, Kolk MA, Paffrath T, Regel G, Sturm JA, Tscherne H. ‘Primary Intramedullary Femur Fixation in Multiple Trauma Patients with Associated Lung Contusion — A Cause of Posttraumatic ARDS?’ J Trauma 1993; 34: 540–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Bosse MJ, Mackenzie EJ, Riemer BL, Brumback RJ, McCarthy ML, Burgess AR, Gens DR, Yasui Y. ‘Adult Respiratory Distress Syndrome, Pneumonia, and Mortality following Thoracic Injury and a Femoral Fracture Treated with Either Intramedullary Nailing with Reaming or with a Plate’. J Bone Joint Surg [Am] 1997; 79A: 799–809.Google Scholar

Copyright information

© Springer-Verlag London Limited 2000

Authors and Affiliations

  • E. Brug
  • S. Winckler
  • M. Püllen
  • W. Klein

There are no affiliations available

Personalised recommendations