[Subsequent fractures of the femur shaft. Classification, etiology and treatment--a retrospective study].

Refractures of the femur frequently occur after open fractures or following an infection. There has to be distinguished between aseptic and septic refractures. Both forms have in common dystrophy as a favoring factor at the time point of refracture. Traumatizing means of osteosynthesis, missing soft tissue protection and lack of medial support after internal fixation are the main factors concerning the development of refractures. In case of aseptic refractures of the femur we propose intramedullary nailing if possible independent of the method of primary osteosynthesis. In case of septic refractures infect repair comes first. Besides internal fixation, autogenous cancellous or cortico-cancellous bone graft and plastic soft tissue repair are of most importance. We propose the following procedure for fractures of the femur with severe soft tissue damage: Primary fixation with fixateur externe, after soft tissue repair electively intramedullary nailing or internal fixation, in case of missing medial support combined with autogenous cancellous or cortico-cancellous bone graft. This procedure showed a rate of 0.9% of refractures after primary operative treatment of 2073 fractures of the femur at the Berufsgenossenschaftliche Unfallklinik Tübingen.