Behandlungsmöglichkeiten nach fehlgeschlagenen Osteosynthesen am Femurschaft mit Pseudarthrosen und Torsionsdifferenzen

Femoral shaft fractures are complex and demanding injuries. Exact repositioning of fragments, protection of soft tissue and a stable osteosynthesis are mandatory. Pseudarthrosis of the femur needs an individual patient-related treatment. With intact biology and little bone loss, simple therapeutic technics can result in healing of the fracture. Infected pseudarthrosis is the most challenging complication. Osteitis needs to be adressed and the soft tissue needs to be reconstructed. Interdisciplinary cooperation between trauma, vascular and plastic surgeons is recommended to achieve good results. Patient guidance is esential because of the prolonged treatment period. Initial surgery planning is crucial as complications can be avoided by adequat first treatment. Postoperative maltorsion and malialignement following antegrade intramedullary nailing is an underestimated complication that can lead to failure in remobilization. An intra- and postoperative control for correct torsion of the lower extremity is recommend and should be recored properly.