Prevention
Because of the lack of treatment options, prevention is very important. The use of profylactic corticosteroïds is studied widely, but because of many different study protocols it is difficult to interpret. Routine prophylaxis is not recommended because the lack of high quality evidence, as well as potential risks of corticosteroid treatment and the low incidence of FES.17,19
Timing of surgery has been a point of interest for many decades. A randomized trial in 1989 compared patients with isolated femur fractures that were randomized to fixation either before 24 hours or after 48 hours. Significantly more pulmonary complications were reported with late intervention.21 Recent literature supports data showing that timely fixation of fractures decreases the incidence of FES.9,21
Studies on the use of intramedullary nailing versus external fixation and reamed versus unreamed nails have been performed but were all underpowered and non-conclusive.22 Early fracture stabilization, slow advancement of the intramedullary nail and technical revolutions like e.g., the reamer head are strategies to limit FE.23