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Primary external fixationfollowed by intramedullary nailing for damage control orthopedics versus primary intramedullary nailing in the polytrauma patient (Update)
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.