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Researchers pinpoint treatment of wartime proximal femoral fractures
Cephalomedullary nail fixation can be used to treat type III subtrochanteric and pertrochanteric fractures sustained in combat. Wound infection and heterotopic ossification topped the list of most common complications
Researchers at Walter Reed National Military Medical Center conducted a retrospective review of 41 patients (39 men and 2 women) who has sustained open proximal femoral fractures. They reviewed patient records, radiographs and laboratory data for time to union, complication rates and patient outcomes. Mean patient age was 25.7 years and follow-up data was available for 2 years postoperatively.
Most patients (71%) sustained blast injuries, while 20% of patients reported with gunshot wounds, 7% of patients were in motor vehicle crashes and 2% of the patients had been in helicopter crashes. The researchers noted 30 type IIIA, six type IIIB and five type IIIC open fractures. The investigators performed cephalomedullary or reconstruction nail fixation in 83% of patients.
Time to union for the fractures averaged 5.1 months and more than half of patients required reoperation for complications. One-third of patients had wound infections and 26% had symptomatic heterotopic ossification, which were the two most common complications.