The benefit of early operative stabilization of
femoral fractures is established in patients with
multiple injuries. In the last few years the unreamed femoral nail is favoured for internal fixation of
femoral fractures despite pathophysiological concerns. The foremost advantage of femoral nails compared with plate fixation is the possibility of early full weight bearing. The aim of this retrospective study was to investigate, under consideration of the severity of injury, the extent of injury, and the
clinical course, if multiple injured patients with concomitant
femoral fractures benefit from the preferred
intramedullary nailing with early weight bearing. Three hundred and two (23.8%) out of 1271 multiple injured patients (ISS > 17) had a concomitant
femoral fracture. Fourty-seven out of 302 patients were children under 16 years of age, remaining 255 patients. Eighteen out of 255 patients died within the first 21 days after
trauma and 66 patients required
mechanical ventilation for more than three weeks (171/255). Thirty patients suffered from severe
head injury (AIS-head > 3) and seven from severe pulmonary
contusion with concomitant
abdominal injury (134/255). Two patients had grade III open
femoral fractures with
vascular injury. Ipsilateral unstable pelvic fractures were seen in 11 patients, seven patients had ipsilateral intraarticular
femoral fractures, and ipsilateral
intraarticular fractures of the lower leg or foot were observed in 40 patients (74/255). The results demonstrate, that only 74 (29%) out of 255 multiple injured patients (> 16 years of age) had a theoretical benefit of early weight bearing. Seventy percent of the patients did not benefit from
intramedullary nailing considering full weight bearing. With regard to pathophysiological concerns alternative methods of
fracture fixation should be discussed for these patients. Primary
fracture fixation with
external fixators and secondary internal fixation proved to be a save alternative method. The complication rate of plating is comparable to
intramedullary nailing but associated with less severe systemic risks. Primary plating of
femoral fractures would not delay mobilization of most multiple injured patients.