ORIGINAL STUDY Acta Orthop. Belg., 2006, 72, 39-43 We report the results of a prospective study of 42 patients with multiple injuries, including femoral fractures, who required intensive care unit (ICU) admission and whose fractures were treated by means of external fixation. The Injury Severity Score (ISS) ranged from 18 to 41 and the average Glasgow Coma Scale (GCS) on admission was 12. Seventeen fractures were open. All patients had their fractures stabilised within 6 hours from admission by means of external fixation. After a follow-up of 11 months (range 4-20), 28 fractures had healed within 6 months (range 4.5-8) and 13 developed non-union which was treated successfully with secondary intramedullary nailing. One patient developed deep infection following secondary nailing and another patient died from adult respiratory distress syn- drome (ARDS). We conclude that external fixation of severe femoral fractures in critically ill patients is an easy and quick method of stabilisation which does not compromise their condition. If however it is intended to be used as a final method, these patients require a close follow-up since the rate of delayed and non-union is high. Keywords : femoral fracture ; external fixation ; multi- ple injuries ; intensive care. INTRODUCTION It is well accepted that early stabilisation of femoral fractures by means of intramedullary nail- ing should be achieved in order to avoid pulmonary complications (pneumonia, adult respiratory dis- tress syndrome, fat embolism syndrome and pul- monary embolus) (4, 5, 23) but controversy exists regarding the method of stabilisation of these frac- tures in multiply injured patients with co-existing severe pulmonary or head injuries. Unreamed intramedullary nailing and plating have been pro- posed as alternative methods for these patients, despite the fact that both can destabilise these patients’ borderline condition. The aim of this study is to report the results achieved in 42 multi- ply injured patients with femoral fractures which were treated with external fixation and, considering the complications noted with this method of treat- ment, to determine whether it can provide an effec- tive alternative for this type of patients. No benefits or funds were received in support of this study Acta Orthopædica Belgica, Vol. 72 - 1 - 2006 External fixation of femoral fractures in multiply injured intensive care unit patients Konstantinos J. KAZAKOS, Dionisios J. VERETTAS, Konstantinos TILKERIDIS, Vasilios G. GALANIS, Konstantinos C. XARCHAS, Alexandra DIMITRAKOPOULOU From Democritous University of Thrace Medical School, Alexandroupolis, Greece ■ Konstantinos J. Kazakos, MD, PhD, Assistant Professor. ■ Dionisios J. Verettas, MD, PhD, Associate Professor. ■ Konstantinos Tilkeridis, MD, Orthopaedic Surgeon. ■ Vasilios G. Galanis, MD, Orthopaedic Surgeon. ■ Konstantinos C. Xarchas, MD, PhD, Assistant Professor. ■ Alexandra Dimitracopoulou, MD, Orthopaedic Surgeon. Department of Orthopaedics, Democritous University of Thrace Medical School, 68100 Alexandroupolis, Greece. Correspondence : Konstantinos C. Xarchas, Smirnis 3-5, N. Hili, Alexandroupolis, 68100, Greece. E-mail : drkcxr@yahoo.com. © 2006, Acta Orthopædica Belgica.