Indications of primary osteosynthesis in patients with fractures of long bones of extremities with special regard to multiple and associated fractures of femur diaphysis.

Fractures of the long shaft-shaped bones were evaluated upto the sixties as an isolated therapeutic problem. During the past fifteen years, however, views as regards treatment of fractures of long bones began to change along with the increasing number of multiple fractures and polytraumas. It was revealed that fractures of the long bones and pelvic fractures have a bearing on the development of the syndrome of fat embolism, the syndrome of acute respiratory distress in adults, on the development of shock damage of the lungs, heart, kidneys, liver, pancreas etc. Evidence was accumulating that unstable fractures of the long shaft-shaped bones contribute towards the development of these complications. During the past ten years stable osteosynthesis of fractures of the long bones, in particular of the lower extremities, has gained priority among operations which have a positive effect on the stabilization of the organism in the early postinjury stage of polytrauma. Modern traumatology solves the dilemma which developed in practice from the need of early osteosynthesis on the one hand and reflections on possible deterioration of the general condition of the organism of the severely injured as a result of urgent or early osteosynthesis, on the other hand. Modern traumatology seeks a basis for objective assessment of conditions and parameters for possible primary or early delayed osteosynthesis in multiple injuries with the aim to shift the indication for stable osteosynthesis of fractures of the femur in multiple injuries to the onset of the stabilization phase.