Immediate plate fixation of highly comminuted femoral diaphyseal fractures in blunt polytrauma patients.

From January 1982 through December 1988, 150 patients with 153 Winquist Class III and IV comminuted diaphyseal femur fractures due to high energy blunt trauma were treated with immediate plate fixation. A total of 260 major general surgical systems were injured in 150 patients. Forty-nine patients did not have adequate preoperative spine radiographs due to positioning or time factors. Nineteen patients had spine fractures; nine were diagnosed post-femoral fixation. The average injury severity score (ISS) was 22.7. Three patients died (2%). Our institution predicted mortality with this ISS for patients without pelvic or femur fractures at 15% (P = .0003). Six patients moved to other states and three were lost to follow up due to noncompliance. One of us reviewed 141 fractures in 138 patients at a minimum of 12 months follow up and completion of treatment. Forty-nine fractures were open; 8 grade I, 25 grade II, 10 grade IIIA, 4 IIIB, 2 IIIC. A total of 153 pelvic or ipsilateral major orthopedic injuries were present in 141 fractures. An additional 188 major associated orthopedic injuries were noted. The average time to union was 17.2 weeks. One plate was applied in 11 degrees of varus. Five plates failed from fatigue and five from repeat traumas. Seven plate failures were rodded and healed within 8 weeks. There was one persistent nonunion. One fracture, open IIIC, became infected after uniting. One patient has 110 degrees of knee motion and 140 fractures have greater than 130 degrees of knee motion. Plate fixation is a safe technique for immediate femoral stabilization in the face of high energy blunt trauma. Failures occur late and are easy to reconstruct. Intramedullary nails are the preferred method of reconstruction. Ultimate knee function is excellent. Infection rates (1/49) in open fractures are acceptably low.