Operative treatment i
Fragmentary segmental fractures are very high energy injuries, often with associated fibular fractures and definitely with significant soft-tissue damage. Whether closed or open, there is a high risk of compartment syndrome, skin envelope injury, muscle crushing, and nerve or vessel injury.
These are unstable injuries, which are usually considered as good candidates for operative treatment, but the possibility of skin and subcutaneous tissue damage may require delay or modified operative approach. Intramedullary nailing or minimally invasive plating, or even initial external fixation are generally preferred to an extensive open procedure. Soft-tissue attachments to the intercalary fragments are at least partially disrupted. Surgical treatment should make great effort to preserve the remaining soft-tissues and thus blood supply to the fracture site.
Bridge plating is applicable to all multifragmented long-bone fractures where intramedullary nailing or conventional plate fixation is not suitable.