Orthopedic Trauma Directions 2011; 9(6): 9-15
DOI: 10.1055/s-0030-1267131
Clinical topic
© Georg Thieme Verlag KG Stuttgart · New York

Primary external fixation

followed by intramedullary nailing for damage control orthopedics versus primary intramedullary nailing in the polytrauma patient (Update)
Further Information

Publication History

Publication Date:
02 January 2012 (online)


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.