The Results of Early and Delayed Internal Fixation of Fractures of the Shaft of the Femur
Postgraduate medical journal
INTRAMEDULLARY fixation of the fractured femoral shaft :is now well established as a method of treatment Ibut the timing of the operation continues -to provoke discussion. Smith (1964) recommended delaying the operation because his non-union rate was 23% when operation was performed within seven days, whereas it was 0.8% if operation was delayed. Charnley and Guindy (~1961) had similar results with 25% non-union in early fixation and 7% in delayed; they recommended delaying operation until
... r at the fracture had become active. Being unconvinced of the -validity of this suggestion, a further consecutive series has been reviewed with contradictory findings. There is a much lower rate of non-union when operation is performed early than they report. Clinical Material During ten years from 1953 to 1963 seventy-one fractures were operated on within twenty-eight days of injury and fixed with a Kiintscher nail. The patients were operated on iby different surgeons at three hosDitals but the after-treatment was along similar lines. Simple, open and pathological fractures have all been included. The only reasons for delaying operation were failure of conservative treatment in those for whom i . t was initially thought to be the method of choice, or associated injuries of higher priority. The ages of the patients, the levels of fracture, and the time intervals between in,jury and operation are sumlmarised in Tables 1 and 2. Early fixation is defined as that 'done within the first six days of inLjury and 'delayed fixation as that done after the first week and within twenty-eight days. In the early operation group, florty-three out of fifty patients were operated on within forty-eight hollrs of injury.