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  • Author: Ahmed Mabrouk x
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Johannes D Bastian Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland

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Silviya Ivanova Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland

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Ahmed Mabrouk Department of Trauma and Orthopaedics, Leeds Teaching Hospitals NHS Trust, United Kingdom

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Peter Biberthaler Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany

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Pedro Caba-Doussoux Servicio de Cirugía Ortopédica y Traumatología, Hospital 12 de Octubre, Madrid, España

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Nikolaos K Kanakaris Department of Trauma and Orthopaedics, Leeds Teaching Hospitals NHS Trust, United Kingdom
Major Trauma Centre, Leeds Teaching Hospitals NHS Trust, University of Leeds, United Kingdom

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  • Segmental femoral fractures represent a rare but complex clinical challenge. They mostly result from high-energy mechanisms, dictate a careful initial assessment and are managed with various techniques. These often include an initial phase of damage control orthopaedics while the initial manoeuvres of patient and soft tissue resuscitation are employed.

  • Definitive fixation consists of either single-implant (reconstruction femoral nails) or dual-implant constructs. There is no consensus in favour of one of these two strategies.

  • At present, there is no high-quality comparative evidence between the various methods of treatment. The development of advanced design nailing and plating systems has offered fixation constructs with improved characteristics.

  • A comprehensive review of the existing evidence with a step-by-step description of these different definitive fixation strategies based on three case examples was conducted. Furthermore, the rationale for using single vs dual-implant strategy in its case is presented with supportive references.

  • The prevention of complications relies mainly on the strict adherence to basic principles of fracture fixation with an emphasis on careful preoperative planning, the quality of the reduction, and the application of soft tissue-friendly surgical methods.

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