NEGLECTED FEMORAL FRACTURES

¹ Orthopaedic Section of the Walter Reed General Hospital, Washington

This series of cases shows failure and success after various methods of treatment for femoral-shaft fractures. Failure results if any method is ill-chosen or misapplied. From the study of these cases, the author submits the following conclusions:

1. Immobilization of the femur in a plaster cast is a good procedure for transportation, but it does not prevent angulation and overriding, and its use for initial definitive treatment is not recommended. Prolonged immobilization in a plaster cast after the plating or bone graft delays the recovery of knee motion.

2. Suspension traction is the simplest and safest method of treatment and its trial is recommended for the average case. This method requires constant attention, the taking of frequent roentgenograms, and prolonged bed care. Distraction must be prevented. Fractures which are not quickly reduced by traction should have prompt open reduction.

3. Dual-pin reduction is suitable in certain cases, particularly for single fractures of the shaft of the femur. It is not recommended for old fractures, for fractures near the joints, or for those with a large, free, displaced fragment. In these cases, traction or operation is preferred. A single half-pin or a wire in each fragment is not sufficient fixation for the femur. In the experience of the author, this method is the least comfortable and the resulting knee motion does not meet expectations. Osteomyelitis does occur, and it is a serious complication that must be avoided.

4. Open reduction is an excellent method of treatment where facilities permit, and should be done as early as possible. However, open reduction with fixation alone does not assure union of the fracture. Success depends upon the use of material which is inert and of sufficient size and strength to be effective, and upon the preservation of an adequate blood supply.

5. Bone-grafting is necessary in cases of non-union, and is recommended when open reduction must be performed more than eight weeks after injury. A massive graft with all layers of bone in firm contact with the host should be firmly fixed with long metal screws. The addition of a plate is not always necessary, but it does ensure fixation, and permits earlier knee motion. The results of this operation have been gratifying in the reconstruction of the femur in these cases.

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