Open femoral fractures are uncommon, and there are very few reports in the literature which refer specifically to their management. The results of the treatment of 31 open femoral fractures with significant bone loss in 29 patients treated in a single Orthopaedic Trauma Unit were reviewed. All fractures underwent wound and bony debridement before skeletal stabilisation at restored femoral length, using primary locked intramedullary nailing or dynamic condylar screw fixation for diaphyseal or metaphyseal fractures respectively. Soft tissue closure was performed at 48 hours in the majority of cases, followed by elective bone grafting procedures for 13 of the fractures. All fractures achieved bony union at an average of 51 weeks (range 20-156 weeks). The time to fracture union and subsequent functional outcome were largely dependent upon the location, type and extent of the bone loss. Union was achieved more rapidly in fractures associated with wedge defects than those with segmental bone loss, and fractures with metaphyseal defects healed more rapidly than those of comparable size in the diaphysis. Metaphyseal wedge fractures did not require any further procedures to achieve union. Complications were more common in the fractures with greater bone loss, which included knee stiffness, delay to union, malunion and leg length discrepancy. One patient had a deep infection, treated by debridement. We have produced an algorithm for the treatment of these injuries, based upon our findings. We feel that satisfactory results can be achieved in most femoral fractures with bone loss, using appropriate initial debridement and modern methods of primary skeletal fixation at a restored femoral length, followed by soft tissue coverage procedures and elective bone grafting, as required.
This study was performed to assess the incidence of generalised ligament laxity in patients presented with recurrent shoulder dislocations. Prospective data was collected for 38 patients with recurrent shoulder dislocations and 43 patients with clavicle fractures as a control group between May 2007 and July 2009, including demographic details, mechanism of injury, number of dislocations and hyperlaxity. Clinical examination was used to assess the ligament laxity using the Beighton score. The mean age was 29 years with a range from 14-40 years. There were 36 males and 2 females. The left shoulder was involved in 21 patients; right in 13 patients and 4 patients had bilateral shoulder dislocations. The average number of dislocations was 3 with a range from 2-17, while the average number of subluxations was 4.5 with a range from 0-35. The average Beighton score for the patients with recurrent shoulder dislocations was 2.8 with a range from 0-8. 17 patients (45%) in this group had a Beighton score of 4 or more as compared to the control group that had only 12 patients (27%) There was a statistically significant difference between the 2 groups with a P value of < 0.05. 8 patients (21%) fulfilled the Brighton criteria for BJHS. The most common cause of recurrent shoulder dislocation was sports related injuries in 26 patients (68%). The most common sport was football in 14 patients (37%) followed by rugby in 10 (26%) patients. We looked at the incidence of generalised ligament laxity in patients with recurrent shoulder dislocations and found a statistically significant difference as compared with the control group. 21% of the patients fulfilled the Brighton criteria for BJHS but 45% had a Beighton score of 4 or more. Appropriate advice should be given to these patients with hyperlaxity and the timing of shoulder stabilisation should be carefully decided.
