Treating femoral fractures with limited resources

An article published in The Journal of Bone and Joint Surgery, British Volume demonstrates that in cases where resources are limited and there is a delay from injury to treatment, femoral fractures can heal successfully without stabilisation by external or internal fixation.

The research was based on treatment of patients at a Red Cross Hospital in Kenya where injuries consisted of bullet wounds caused during the current conflict in neighbouring Sudan and therefore there was over 24 hours between injury and treatment owing to the long distances involved and lack of available transport. In current practice it is believed that these wounds must be treated without delay, despite the fact that recent reports have shown that delays up to 24 hours do not affect the outcome.

While the authors do not advocate delaying treatment, of the 52 patients treated for ballistic fractures of the femur three required amputation for persisting infection. 48 of the fractures healed, with 15 patients mobilised early requiring only plaster protection acting as a simple form of functional brace.

With the advances in fractures techniques, methods such as traction and plaster have come to be seen as inadequate, however, the study shows that femoral fractures can heal in times when resources are limited, such as in less developed countries.

(Source: The Journal of Bone and Joint Surgery: Department of Education Royal College of Surgeons of Edinburgh: January 2009)