Der Unfallchirurg
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The femur is the largest, longest and strongest bone in the human skeleton. Fractures of the shaft of the femur can result from high energy as well as low energy trauma and 30% of patients have multiple injuries. In the clinical diagnostic special attention must be paid to the peripheral neurovascular status as well as the possibility of a compartment syndrome. ⋯ Full weight bearing is possible immediately following the operation depending on the type of fracture and method of treatment. Uncomplicated fracture healing does not result in a reduction in the ability to work. Despite the generally good prognosis and improvement in design and technology of implants, fractures of the femur shaft still represent a special challenge for the treating casualty surgeon.
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In the coming years, our approach to the bleeding patient will have to change radically. The inevitable knowledge from the wars in Iraq and Afghanistan permits the prediction that conventional crystalloids will sooner or later disappear from volume replacement therapy. The dogma that fluids must always be given will be abandoned, to be replaced by the practice of careful and goal-directed resuscitation. In the near future, we would rely on designer fluids and sophisticated pharmacological agents to deliver personalized resuscitation based upon the specific needs of the individual patient.