Prolonged femoral external fixation after natural disaster: Successful late conversion to intramedullary nail aboard the USNS Mercy hospital ship


  • V. Franklin Sechriest II, MD, CDR, MC, USN
  • David W. Lhowe, MD





After the 9.0 magnitude earthquake and tsunami of December 26, 2004, orthopaedic injuries were a major healthcare problem in parts of South East Asia. We report our late encounter with an Indonesian patient treated acutely with external fixation of a femur fracture. We describe our procedure for conversion of prolonged external fixation (59 days) to an intramedullary nail (IMN) aboard the USNS Mercy and provide two-year follow-up. A review of current literature on conversion of femoral external fixation to IMN is included.This report highlights the potential pitfalls of external fixation of femur fractures in an austere postnatural disaster environment where orthopaedic follow- up care may be delayed or nonexistent.

Author Biographies

V. Franklin Sechriest II, MD, CDR, MC, USN

Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, California.

David W. Lhowe, MD

Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts.


Redwood-Campbell LJ, Riddez L: Post-tsunami medical care: Health problems encountered in the International Committee of the Red Cross Hospital in Banda Aceh, Indonesia. Prehospital Disaster Med. 2006; 21(1): s1-s7.

Calder J, Mannion S: Orthopaedics in Sri Lanka post-tsunami. JBJS. 2005; 87B(6): 759-761.

Fan SW: Clinical cases seen in tsunami hit Banda Aceh: From a primary health care perspective. Ann Acad Med Singapore. 2006; 35(1): 54-59.

Leppaniemi A, Vuola J, Vornanen M: Surgery in the air— Evacuating Finnish tsunami victims from Thailand. Scand J Surg, 2005; 94(1): 5-8.

Ammartyothin S, Ashkenasi I, Schwartz D, et al.: “Medical response of a physician and two nurses to the mass-casualty event resulting in the Phi Phi Islands from the tsunami,” Prehospital Disaster Med. 2006; 21(3): 212-214.

Sechriest VF, Lhowe DW: Orthopaedic care aboard USNS Mercy during Operation Unified Assistance after the 2004 Asian tsunami: A case series. JBJS. 2008; 90A: 848-861.

Della Rocca GJ, Crist BD: External fixation versus conversion to intramedullary nailing for definitive management of closed fractures of the femoral and tibial shaft. JAAOS. 2006; 14(10): S131-S135.

Gosselin RA: War injuries, trauma, and disaster relief. Tech Orthop. 2005; 20(2): 97-108.

Dabezies EJ, D’Ambrosia R, Shoji H, et al.: “Fractures of the femoral shaft treated by external fixation with the Wagner device,” JBJS. 1984; 66A: 360-364.

Mohr VD, Eickhoff U, Haaker R, et al.: External fixation of open femoral shaft fractures. J Trauma. 1995; 38(4):6 48-652.

Has B, Nagy A, Pavic R, et al.: External fixation and infection of soft tissues close to fracture localization. Mil Med. 2006; 171(1): 88-91.

Alonso J, Geissler W, Hughes JL: External fixation of femoral fractures: indications and limitations. CORR. 1988; 241: 83-88.

Broos PL, Miserez MJ, Rommens PM: The monofixator in the primary stabilization of femoral shaft fractures in multiply-injured patients. Injury. 1992; 23(8): 525-528.

Wu CC, Shih CH: Treatment of open femoral and tibial shaft fractures: Preliminary report on external fixation and secondary intramedullary nailing. J Formosan Med Assoc. 1991; 90(12): 1179-1185.

Nowotarski PJ, Turen CH, Brumback RJ, et al.: Conversion of external fixation to intramedullary nailing for fractures of the shaft of the femur in multiply injured patients. JBJS. 2000; 82A: 781-788.




How to Cite

Sechriest II, MD, CDR, MC, USN, V. F., and D. W. Lhowe, MD. “Prolonged Femoral External Fixation After Natural Disaster: Successful Late Conversion to Intramedullary Nail Aboard the USNS Mercy Hospital Ship”. American Journal of Disaster Medicine, vol. 3, no. 5, Sept. 2008, pp. 307-12, doi:10.5055/ajdm.2008.0038.



Case Studies

Most read articles by the same author(s)