[Minimally invasive plate osteosynthesis in the treatment of femur fractures due to gunshot injuries].

OBJECTIVES

The results of treatment with minimally invasive plate osteosynthesis were evaluated in open comminuted femur fractures due to high-velocity gunshot injuries.

METHODS

Seventeen patients (15 males, 2 females; mean age 34 years; range 15 to 67 years) with open comminuted femur fractures due to high-velocity gunshot injuries were included. The fractures were classified according to the AO system. Timing of minimally invasive percutaneous plate fixation was determined according to the classification of open fractures in the Gustilo-Anderson system. There were seven subtrochanteric, seven supracondylar, and three diaphyseal fractures. During surgical exploration, two patients underwent vascular repair for related pathologies. No exploration was performed in two cases with neurological damage. Seven patients were operated on in the early period (mean 1.3 days; range 1 to 2 days) and 10 patients in the late period (mean 11.1 days; range 7 to 15 days). The mean follow-up was 25 months (range 14 to 42 months).

RESULTS

Union was obtained in a mean of 4.4 months (range 2.5 to 7 months) in 16 patients. Autogenous grafting was performed in four patients who presented with a cavitation and defect in the late period and in one patient due to delayed union in the postoperative fourth month. Complications included superficial infection in one patient (5.9%), deep infection in one patient, and leg length discrepancy (0.5 cm to 2 cm) with a varus-valgus angulation (mean 5 degrees , range 3 to 8 degrees ) in eight patients (47.1%). No refractures occurred during the follow-up period.

CONCLUSION

Minimally invasive percutaneous plate fixation can be considered an alternative technique in type IIIA and IIIB open fractures resulting from high-velocity gunshot injuries.