The cases of 86 patients in whom 89 open fractures of the femoral shaft had been treated by intramedullary nailing with reaming were retrospectively reviewed. 27 fractures were classified as grade-I open fractures; 16, as grade-II open fractures; and 46, as grade-III open fractures. Immediate intramedullary nailing was done for 56 fractures, and delayed stabilization (5 to 7 days after delayed closure of the wound) was done for 33 fractures. A prerequisite for immediate intramedullary nailing was that irrigation and debridement of the open wound be done within 8 hours after injury. All fractures healed in an average of 5.2 months. No infections occurred in the 62 grade-I, grade-II, or grade-IIIA open fractures, regardless of whether immediate or delayed intramedullary nailing was performed. Of the 27 grade-IIIB fractures, infection developed in 3: in one after immediate intramedullary nailing and in 2 after delayed intramedullary nailing. We concluded that, if a thorough and timely debridement can be accomplished, immediate intramedullary nailing of grade-I and grade-II open fractures of the femoral shaft does not increase the risk of postoperative infection. Selected patients who have a grade-III open fracture may be candidates for immediate intramedullary stabilization, depending on the degree of the patient's associated injuries and the extent of disruption and contamination of the soft tissues of the thigh.
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The cases of 86 patients in whom 89 open fractures of the femoral shaft had been treated by intramedullary nailing with reaming were retrospectively reviewed. 27 fractures were classified as grade-I open fractures; 16, as grade-II open fractures; and 46, as grade-III open fractures. Immediate intramedullary nailing was done for 56 fractures, and delayed stabilization (5 to 7 days after delayed closure of the wound) was done for 33 fractures. A prerequisite for immediate intramedullary nailing was that irrigation and debridement of the open wound be done within 8 hours after injury. All fractures healed in an average of 5.2 months. No infections occurred in the 62 grade-I, grade-II, or grade-IIIA open fractures, regardless of whether immediate or delayed intramedullary nailing was performed. Of the 27 grade-IIIB fractures, infection developed in 3: in one after immediate intramedullary nailing and in 2 after delayed intramedullary nailing. We concluded that, if a thorough and timely debridement can be accomplished, immediate intramedullary nailing of grade-I and grade-II open fractures of the femoral shaft does not increase the risk of postoperative infection. Selected patients who have a grade-III open fracture may be candidates for immediate intramedullary stabilization, depending on the degree of the patient's associated injuries and the extent of disruption and contamination of the soft tissues of the thigh.
Copyright remains with the authors and publisher.