EXPERIENCES WITH INTRAMEDULLARY FIXATION OF COMPOUND FEMORAL FRACTURES IN WAR WOUNDS

¹ United States Naval Hospital, Oakland, California

The authors have presented a group of compound fractures of the femur due to gunshot wounds, which they have stabilized by intramedullary fixation. These were a small portion of the scores of such injuries which came under our care or observation during the first six months of the Korean conflict. To our knowledge many more operations of this type have been performed, but at this time it is not possible to correlate the combined experience of those engaged in using this technique.

In our series we have had no catastrophes, no major loss of limb, and no deaths which could be attributed to the technique. In fact, none of the patients in whom we have used pin has as yet succumbed from any cause.

It is the authors' opinion that, if such a technique is to be used, all the basic principles modern war surgery must be carefully adhered to. Sufficient initial débridement, good after-care, and the proper selection of the time interval for internal fixation will determine outcome.

Intramedullary stabilization by itself cannot overcome infection in bone. However, immobilization of the fracture permits the return of bodily vigor and mental health and prevents complete disuse and atrophy of the limb. As a result, it enhances the healing of bone in the presence of infection.

The authors are of the opinion that, if these wounds have not healed prior to surgery, they should be left open and treated as open infected wounds. The presence of the metallic nail does not retard this healing but hastens it ; the nail, therefore, should not be removed during the healing process unless it is clearly evident that it is poorly placed mechanically and is contributing to the persistence of the infection. This has not occurred in any cases observed by us.

With proper selection of cases, adequate armamentarium, and properly trained surgeons, this technique is feasible, and when compared with alternatives is safe.

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