Zeitschrift für Orthopädie und Unfallchirurgie
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In polytraumatised patients, fracture management depends on the overall injury severity. For decision making, patients are grouped in one of four categories (STABILE, BORDERLINE, INSTABLE and IN EXTREMIS). STABILE patients should and BORDERLINE patients may undergo primary definitive fracture stabilisation; in contrast, this is not recommended for INSTABLE or IN EXTREMIS patients. ⋯ The indication for fasciotomy covers a wide field and may be performed prophylactically. The decision for amputation is based on the patient's general condition and the soft-tissue and neurovascular status. Scoring systems are useful for decision making, however individual decisions should be made.
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Intramedullary nailing is a standard procedure to treat femoral fractures in patients without polytrauma. Nevertheless, non-union in femoral fractures is a common complication with an incidence of 12.5 percent, mostly arising for mechanical reasons. The aim of this study is to find out whether the increase of stability through an augmentive plate fixation (if necessary with bone grafting) with leaving the nail in situ is adequate to treat the non-union successfully. ⋯ If indicated, the herein demonstrated procedure with an augmentive plate fixation while leaving the nail in situ is simple and safe. Although the intramedullary canal is potentially affected through the initial nailing, the healing of femoral non-unions was observed in the majority of cases in spite of the additional extramedullary approach for plating and bone grafting.