Open versus closed nailing of femoral fractures in the polytrauma patient

Thirty-four patients with severe multiple injuries underwent either open or closed nailing of 35 femoral fractures. Open nailing was performed in 17 femurs and closed nailing in 18 femurs. The average abbreviated injury score was 27 in both the open group (range: 17-45) and closed group (range: 22-36). Soft tissue injuries were present in eight (47%) cases in the open group compared to three (16%) in the closed group. The treatment protocol was similar in both groups. Intramedullary nailing was delayed an average of 11 days in the closed group. This was significantly different than the open group where the average time to nailing was less than 24 hours (p less than 0.001). Reamed nails were used in all cases except for two in the closed group. The median time to fracture healing was 5.0 months in the open group and 4.1 months in the closed group, with an average follow-up of 18 months in both groups. Two cases required reoperation (one nonunion and one shortening at the fracture site). Both these cases were in the open group. There were no superficial or deep infections in either group. Closed reamed intramedullary nailing is recommended for treatment of diaphyseal femur fractures in patients with severe coexistent injuries. Open nailing should be reserved for cases in which an adequate reduction cannot be achieved by closed methods.