Plate osteosynthesis in posttraumatic deformities of the femoral shaft

The success of precisely indicated surgical treatment of posttraumatic deformities of the femur shaft depends on painstaking preoperative planning with exact assessment of the locus of correction, careful determination of the correction angle, and choice of an adequate operation method. In correction operations plate osteosynthesis is necessary, in contrast to the various possibilities for care of primary fractures of the femur. Therefore we concentrate in this paper mainly on the use of plate osteosynthesis, without forgetting that there are also indications for intramedullary nailing, especially of not yet consolidated fractures or aseptic wound healing impairments. Long X-rays of the leg are an essential part of the preoperative preparation. The success of all operative treatments does not depend only on the degree of disablement, the age of the patient, and realistic target. Particularly in view of the difficulty of plate osteosynthesis and the variety of methods of primary osteosynthesis, the surgeon has to consider the rules of biomechanics as they apply to the incorrectly set femur and to simulate the surgical treatment with preoperative planning in order to attain physiological axial conditions with the best operative method. This applies particularly to the knee joint. Axial deformities are very often combined with shortening, and surgical correction is therefore sometimes difficult.