Refractures of the femoral shaft.

A retrospective analysis of refracture in 148 femoral shaft fractures is presented. Nineteen (13%) refractures occurred, mostly after plate fixation. Based on the outcome of this analysis and on the literature, recommendations are given to prevent refracture of the femoral shaft after primary therapy by a plate-osteosynthesis. If possible external compression should be used in the treatment of femoral fractures. Cancellous bone grafting should be carried out in all fractures with medial cortical bone defects, or if there is devascularization of bone fragments. Furthermore, a delayed cancellous bone graft (8-12 weeks after primary surgery) is advocated in some of these fractures.