Aim: To review the operative results and to determine factors that may significantly influence the outcome.

Method: We retrospectively reviewed 38 patients treated with femoral interlocking nailing and tibial external fixation in a 5-year period (1996–2000). Two patients were excluded because of early death. Minimum follow-up was 2 years. There were 29 men and 7 women with a mean age of 27 years. Eight femoral (22%) and 29 tibial fractures (81%) were open. Associated injuries to th head, chest, and abdomen were seen in 17 patients (47%). Concomitant musculoskeletal trauma was present in 30 patients (83%). Final functional results were evaluated according to Karlstrom’s and Olerud’s criteria. Various factors were assessed including age, severity of open fractures, neurovascular injuries, fracture comminution, ligamentous knee injuries, concomittant injuries in the same limb or in the contralateral limb, existence of multiple trauma. Multivariate models were derived to detetermine predictors of outcome.

Results: All femoral fractures and 31 tibial fractures (86%) united without additional intervention. Radiographic femoral union averaged 14 weeks and tibial union 20 weeks. A total of 18 secondary procedures were required. Functional results were excellent or good in 26 patients (72%). Increasing age, fracture comminution and associated injury in the contralateral limb were not influenced the final result. Open grade III tibial fractures (p< 0.03), severity of knee ligamentous injury (p< 0.02) and concomitant trauma to the same extremity (particularly to the ankle and foot – p< 0.02), contributing significantly to an unsatisfactory outcome.