Femoral fractures : indications an[d] biomechanics of external fixation

Internal fixation can be carried out in various ways. For femoral shaft fractures, an (interlocking) nail is becoming increasingly popular, instead of open realignment of the fracture. External fixation, which has become a generally accepted method of treating fractures of the lower leg, has been used infrequently on the upper leg. During the last 100 years, several different types of external fixation have been tested on femoral shaft fractures on a limited scale in various parts of the world. It is clear that external fixation offers good prospects for treating serious, (possibly) comminuted, compound femoral shaft fractures (often in combination with blood vessel and nerve injuries). Only a few authors elect to use external fixation on all femoral shaft fractures, including those in children. Various views exist on the indications, treatment schemes and adjunct therapy. The search for similarities and background information was one of the first objectives of this study. The biomechanical aspects play a central part in this. An overview of the literature on the treatment of femoral fractures is given and the relationship between the anatomy of the upper leg and external fixation is investigated. Experimental models have been used to answer the question of what forces act upon the femur and how they are neutralized by external fixation. The histological aspects of fracture healing during stable and unstable (external) fixation are discussed briefly together with their clinical consequences. A large proportion of this thesis is taken up by biomechanical research, in which the rigidity and elastic deformation of 12 different external fixation frames (applied to the femur) were analyzed. To illustrate the clinical prospects (and the relationship with biomechanical studies) representative case histories of patients have been added

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