Internal fixation can be carried out in various ways. For femoral shaft fractures, an
(interlocking) nail is becoming increasingly popular, instead of open realignment
of the fracture. External fixation, which has become a generally accepted method
of treating fractures of the lower leg, has been used infrequently on the upper leg.
During the last 100 years, several different types of external fixation have been
tested on femoral shaft fractures on a limited scale in various parts of the world.
It is clear that external fixation offers good prospects for treating serious, (possibly)
comminuted, compound femoral shaft fractures (often in combination with blood
vessel and nerve injuries). Only a few authors elect to use external fixation on all
femoral shaft fractures, including those in children. Various views exist on the
indications, treatment schemes and adjunct therapy. The search for similarities and
background information was one of the first objectives of this study. The biomechanical
aspects play a central part in this. An overview of the literature on the treatment of femoral fractures is given and the
relationship between the anatomy of the upper leg and external fixation is
investigated. Experimental models have been used to answer the question of what
forces act upon the femur and how they are neutralized by external fixation. The histological aspects of fracture healing during stable and unstable (external)
fixation are discussed briefly together with their clinical consequences.
A large proportion of this thesis is taken up by biomechanical research, in which
the rigidity and elastic deformation of 12 different external fixation frames
(applied to the femur) were analyzed. To illustrate the clinical prospects (and the
relationship with biomechanical studies) representative case histories of patients
have been adde