Session IV - Femur

Bone Loss in Open Femoral Fractures

John Keating; Christopher Adams; Patricia Hurley; Michael Robinson, Edinburgh Royal Infirmary, Edinburgh, Scotland

Purpose: To define indications for bone grafting and revision nailing in the management of bone loss following intramedullary nailing.

Methods: A series of 110 open femoral fractures were treated by reamed intramedullary nailing. There were 18 grade I, 16 grade II, 37 grade IIIA, 26 grade IIIB and 13 grade IIIC injuries. Following debridement, 25 patients had significant bone defects. Segmental or wedge defects in excess of 2 cm in length were considered significant. These cases were analysed to define the need for revision nailing and bone grafting.

Discussion: There were 9 wedge defects and 16 segmental defects. The mean length of wedge defects was 3.3 cm (range 2-5 cm) and of segmental defects was 6 cm (range, 3-11 cm). Patients with wedge defects of between 2 and 3 cm (4 cases) healed without intervention. Wedge and segmental defects between 3 and 6 cm (13 cases) healed following revision nailing. Segmental defects between 6 and 11 cm (8 cases) healed with bone grafting and revision nailing. One patient with an 11-cm defect required bone grafting on 3 occasions to obtain union.

Results: The results of the present study indicate that femoral bone defects less than 6 cm in length can be managed by revision nailing if union fails to occur. Defects in excess of this length will require bone grafting and revision nailing. Defects in excess of 10 cm may be better managed by more complex treatments.