OPEN FEMORAL FRACTURE DURING A WAR - 173 APPLICATIONS OF INTERNAL-FIXATION TO THE FEMUR (WAR IN AFGHANISTAN)

During the three years 1988 through 1990, more than 700 external skeletal fixations (AO/ASIF Tubular System) were utilized at the ICRC Hospital for Afghan War Wounded in Peshawar, Pakistan, 173 of which were for femoral fractures. 13% of the fractures were open grade II, and 71% open grade III, mostly due to high velocity gunshot or shrapnel injuries. Usually, the external fixator was left in place until consolidation of the fracture. The average time of external fixation was 128 days. Three major groups of complications have been observed: fracture complications, implant complications, and residual loss of function of the knee joint, probably the most significant permanent complication to the patient. In order to improve the functional results in treating open fractures of the femur. three measures are recommended: unilateral frame with posterolateral insertion of Schanz screws. postoperative positioning of the patient with 90-degrees of flexion of hip and knee joints and mobilization of the patient as soon as possible (on the first or second postoperative day).