Treatment of open femoral and tibial shaft fractures preliminary report on external fixation and secondary intramedullary nailing.

From January 1987 to May 1989, a total of 38 adult cases were treated with 15 femoral and 25 tibial shaft shifting procedures from external fixation to reamed intramedullary nailing and followed up for at least 1 year (average, 23 months) at the authors' institution. The indications for the shifting procedures included routine sequential femoral external fixation and failed tibial external fixation treatment such as loss of reduction, atrophic healing process and inability of patients to tolerate casting. The delay period for the shifting procedure was 5 days in the femur and 48 days in the tibia. The union rate for the femur was 93% (14/15), and the tibia, 96% (24/25). The union period after the shifting procedure was 4.8 +/- 1.7 months in the femur, and 5.2 +/- 1.8 months in the tibia. Range of motion of the knee and ankle were satisfactory. Deep infection was the most serious complication, and the tibia was involved more often than the femur (20% to 13%) (p greater than 0.05). The most favorable management of deep infection was local drainage till bony union. We conclude that a shifting operation can be considered as one of the alternative procedures for several femoral or tibial shaft open fractures after fixation with external fixation. Wound and pin tract care, a shorter period of external fixation, a longer delay period before nailing, and perioperative antibiotic use may significantly lessen the infection rate.