Question

A young adult presents with chest trauma, haemodynamic instability and fractures of bilateral femur and tibia. After the patient has been resuscitated and rendered haemodynamically stable, what is the most appropriate definitive management of the long-bone fractures?

• A. Intramedullary nailing of the femurs and external fixation of the tibiae
• B. Plating of the tibiae and external fixation of the femurs
• C. Nailing / plating / external fixation as per whichever procedure the surgeon can perform fastest
• D. External fixation of both femurs and both tibiae

Hint:

Once stable: IM nailing is definitive for femur shaft; tibiae get external fixation.

Answer 1

The Correct Option is A

The decision in a multiply-injured patient with chest trauma and four long-bone fractures depends on physiological status. The stem states resuscitation has succeeded and the patient is haemodynamically stable, so we are choosing definitive rather than temporary fixation.

Guiding principles:
$1.$ For an unstable patient, perform damage-control external fixation of all long bones - quick, low-stress, life-saving.
$2.$ For a stabilized patient, proceed to the best long-term implant per bone.

Applying principle $2$ here:
$\bullet$ Femur: closed intramedullary nail - the recognised gold-standard definitive treatment of diaphyseal femoral fractures, enabling early rehabilitation.
$\bullet$ Tibia: external fixation provides a safe, low-burden definitive option given the systemic and soft-tissue insult already sustained.

Reversing the constructs (option 2), choosing the fastest technique (option 3, a DCO concept for the unstable), or externally fixing everything definitively (option 4) are all inferior here.
\[\boxed{\text{Nail the femurs; external fixation of the tibiae}}\]