INTRODUCTION: Femoral fractures are most often the result of a high-energy mechanism. Their primary treatment, definitive management and addressing of impaired healing are still a matter of discussion. AIM: The aim of the study was to analyse the causes of impaired healing of femur, infectious complications and their possible solutions. METHODOLOGY: It is a retrospective study of 1,433 patients from years 2014 to 2018. We focused on a group of polytrauma patients with NISS > 15, who also suffered a diaphyseal or distal femur fracture. Of this cohort, 178 patients died. Of the remaining 998 patients with NISS > 15, 82 patients (8 %) suffered a concomitant diaphyseal or distal femur fracture. RESULTS: The fracture healed without the need for further intervention in 84 % of cases. In two patients (2.6 %), the condition was assessed as prolonged healing. Primary non-healing occurred in a total of 6 patients (8 %). DISCUSSION: Replacement of the nail with a thicker nail after reaming the medullary cavity and with the possible addition of positional screws is most commonly used to manage the impaired healing of femur. The success rate of this technique ranges from 75 to 100 %. Another possible surgical technique is the augmentation of the existing nail with an additional plate, which has proven to be particularly successful in the infraisthmic portion of the diaphysis, i.e. in the distal third. The success rate of this method exceeds 90 %. The third possible surgical technique is a conversion of intra-articular osteosynthesis to plate osteosynthesis. Its importance is seen in the necessary conversion of relative to absolute stability. CONCLUSION: The causes of impaired bone healing are mechanical, biological, and a combination of both. The mechanical cause may be insufficient stability or, on the contrary, excessive rigidity of the osteosynthesis, which does not result in muscle formation. The biological cause is most often a malnutrition of the fracture fragments. Then, by discovering the cause of the impaired healing, we can achieve healing with the right intervention.

Fakulta vojenského zdravotnictví Hradec Králové Univerzita obrany v Brně Katedra vojenské chirurgie Fakultní nemocnice

Hradec Králové Chirurgická klinika Oddělení úrazové chirurgie

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