Primary external fixation

Summary

One randomized controlled trial (RCT) and three retrospective cohorts do not provide conclusive evidence for either a damage-control approach or primary fixation for femoral fractures in the polytrauma patient. Differences were found in subgroup analysis in the RCT, with significantly more time spent on ventilator by Damage-control orthopedics (DCO) patients in stable condition compared with primary IM nailing patients; whereas in borderline condition patients, less acute lung injury occurred in DCO patients compared with primary IM nailing patients. Prospective and/or randomized studies that control for injury severity are needed to answer the question of optimal timing for femur fixation.