DELAYED SURGICAL FIXATION OF FEMUR FRACTURES IS A RISK FACTOR FOR PULMONARY FAILURE INDEPENDENT OF THORACIC TRAUMA

Abstract

A recent retrospective analysis of femur fractures concluded that early surgical fixation in patients who have sustained blunt thoracic trauma (AIS score for Thorax 2) was a risk factor for postoperative pulmonary failure. We conducted a review of all femur fractures admitted to a level I trauma center from November, 1988 to May, 1993. Inclusion criteria were ISS 18, mid-shaft femur fractures treated with reamed intramedullary fixation, and no mortalities secondary to head trauma or hemorrhagic shock. One hundred thirty-eight patients met these criteria. Four patient groups were created: N1—no thoracic trauma (AIS score for thorax < 2), and early surgical fixation (p = 0.07). The T2 patients had a pneumonia rate of 48% compared with 14% in group T1 (p = 0.002). The overall pulmonary complication rate (pneumonia, adult respiratory distress syndrome, fat embolism syndrome, and pulmonary embolus) was 56% in group T2 compared with 16% in group T1 (p = 0.007). We conclude that delayed surgical fixation is associated with a higher pulmonary complication rate, independent of blunt thoracic trauma.