Possibilities of application of the fixateur externe at the femur - indications, results (author's transl)

Besides the methods of screwing of plates and medullary nailing, the fixateur externe (F.E.) is another method which can be considered for treating bone fractures at the femur, F.E. being an exceptional indication. In fresh fractures of the femur, open fractures of the second and third grade as well as debris and multiple-plane fractures are typical indications for F.E. Over and above, F.E. is almost always indicated as an emergency measure in case of initial inoperability (polytrauma, shock, loss of blood, craniocerebral trauma) or continuing general inoperability. F.E. has been found useful to an even greater extent especially in old fractures, refractures, pseudarthroses and infected pseudarthroses. Combined treatment of the infected pseudarthroses with F.E. and Septopal balls has proved particularly effective. The special advantages of F.E. application at the femur are blood-saving surgery requiring relatively little time and technical equipment, avoidance of surgically conditioned infection risk in the fractured region, avoidance of additional denudation of free fracture fragments, long-term applicability, good external stabilization with selective possibility between compression, distraction and neutral positioning of the fractured area, postoperative treatment without dressing, and free access to the fractured area without interfering with the F.E.; furthermore, exchangeability of the F.E., possibility of correcting the position and axis without surgical intervention, non-fixation of the adjacent joints and maintenance of physiotherapeutic treatment possibilities. F.E. is "panacea" and should not be applied without exact knowledge of the static and mechanical and biomechanical conditions and effects. Before resorting to F.E. this must be carefully weighed against the use of internal osteosynthesis methods. It is not a rival method to plate screwing and medullary nailing but rather an auxiliary system whenever these methods are inapplicable or would entail disadvantages.