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