[Multilevel injuries of the upper and lower legs : Strategies for osteosynthetic treatment].

Background: Multilevel fractures are breaks of a single bone at multiple levels, often as a combination of diaphyseal and metaphyseal sections. They are usually caused by the effect of strong direct force. Combined injuries of a bone are fractures accompanied by joint distortion. This results in ligament ruptures or avulsions together with a shaft fracture. Surgical treatment is always challenging and requires a differentiated approach.

Objective: The aim of this review article is to highlight the diagnostic and surgical procedures for multilevel fractures. Particular attention is paid to the importance of the fracture location and joint involvement in order to ensure targeted treatment for functional restoration.

Material and methods: A literature search was conducted to identify possible treatment strategies. In addition, clinical case studies from our own patient population were reviewed and discussed.

Results and conclusion: Multilevel injuries rarely occur in both the femur and tibia. In cases of compromised soft tissue or unstable cardiac circulation, external fixation is the primary treatment. For femoral fractures all-in-one, miss-a-nail or rendezvous techniques are common options for definitive treatment. In multilevel fractures of the tibia, the strategy depends on the involvement of the joint. Anatomical joint reconstruction is the top priority. The goal in shaft fractures is always to restore the axis, length and rotation. An accompanying fibular shaft fracture can be indicative of a fracture of the upper ankle joint. Restoration of ankle joint congruency is then essential.