External fixation followed by delayed interlocking intramedullary nailing in high velocity gunshot wounds of the femur.

Background: High velocity gunshot-related fracture is associated with massive soft tissue damage and severe comminution at the fracture site. This unique type of open fracture presents a serious challenge to the orthopedic traumatologist.

Methods: The study was conducted prospectively involving patients who presented to the Accident and Emergency Department of the Bone and Joint Surgery Hospital Srinagar (India), from January 2005 to March 2007, with a history of high velocity gunshot wounds to the femur. Initial stabilization with external fixation was followed by delayed interlocking intramedullary nailing. The patients were followed for an average period of 26 months (range, 15-39 months).

Results: All the patients were males, with an average age of 37 years (range, 22-52 years). Twenty-four (65%) were type IIIA, 11 (30%) were type IIIB and 2 (5%) were type IIIC. All the fractures united in good alignment in an average time of 24 weeks.

Conclusion: External fixation as a primary modality of treatment provides more than adequate stabilization to facilitate nursing, good wound care and physiotherapy. A staged protocol of primary temporary fixation by unilateral external fixation followed by delayed reamed intramedullary interlocking nail seems to be an effective method of treatment for high energy gunshot femoral fractures.