• Injury · Aug 2022

    The management of segmental femur fractures: the radiographic 'cover-up' test to guide decision making.

    • Nando Ferreira, Elsabe Britz, Alan Gould, and William D Harrison.
    • Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa. Electronic address: nferreira@sun.ac.za.
    • Injury. 2022 Aug 1; 53 (8): 2865-2871.

    BackgroundSegmental femur fractures often pose management challenges regarding the optimal fixation choice and sequence of surgical events.MethodsRetrospective review of clinical records and radiographic data of adult patients with segmental femur fractures treated by a conceptual radiographic cover-up test to determine the ideal fixation method between January 2019 and December 2020.ResultsForty patients with 84 individual fractures underwent fracture fixation. The most consistent fracture combinations were intertrochanter-diaphysis (AO31A-AO32) fractures (25%, n = 10) and femur neck-diaphysis (AO31B-AO32) fractures (20%, n = 8). Compared to evidence-based fracture management, the gold standard treatment was used for the fixation of 78 fractures (93%). One patient required revision for fixation failure of a diaphyseal fracture, and two fractures, both open diaphysis injuries, developed fracture-related infections.ConclusionAnatomical alignment and high union rates are possible for segmental femur fractures treated by evidence-based fracture fixation principles. A conceptual radiographic cover-up test assists in matching the best possible implant for each fracture.Copyright © 2022. Published by Elsevier Ltd.

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