Impact of the Method of Initial Stabilization for Femoral Shaft Fractures in Patients With Multiple Injuries at Risk for Complications (Borderline Patients)
- 1 September 2007
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Annals of Surgery
- Vol. 246 (3), 491-501
- https://doi.org/10.1097/sla.0b013e3181485750
Abstract
The timing of definitive fixation for major fractures in patients with multiple injuries is controversial. To address this gap, we randomized patients with blunt multiple injuries to either initial definitive stabilization of the femur shaft with an intramedullary nail or an external fixateur with later conversion to an intermedullary nail and documented the postoperative clinical condition. Multiply injured patients with femoral shaft fractures were randomized to either initial (16 points, or 3 fractures and Abbreviated Injury Scale score ≥2 points and another injury (Abbreviated Injury Scale score ≥2 points), and age 18 to 65 years. Exclusion: patients in unstable or critical condition. Patients were graded as stable or borderline (increased risk of systemic complications). Incidence of acute lung injuries. Ten European Centers, 165 patients, mean age 32.7 ± 11.7 years. Group intramedullary nailing, n = 94; group external fixation, n = 71. Preoperatively, 121 patients were stable and 44 patients were in borderline condition. After adjusting for differences in initial injury severity between the 2 treatment groups, the odds of developing acute lung injury were 6.69 times greater in borderline patients who underwent intramedullary nailing in comparison with those who underwent external fixation, P Conclusion: Intramedullary stabilization of the femur fracture can affect the outcome in patients with multiple injuries. In stable patients, primary femoral nailing is associated with shorter ventilation time. In borderline patients, it is associated with a higher incidence of lung dysfunctions when compared with those who underwent external fixation and later conversion to intermedullary nail. Therefore, the preoperative condition should be when deciding on the type of initial fixation to perform in patients with multiple blunt injuries.Keywords
This publication has 70 references indexed in Scilit:
- Ventilatory management of acute lung injury by neurally adjusted ventilatory assist and positive end-expiratory pressure*Critical Care Medicine, 2006
- Patterns of Errors Contributing to Trauma MortalityAnnals of Surgery, 2006
- Damage Control: Collective ReviewThe Journal of Trauma and Acute Care Surgery, 2000
- Early Fracture Fixation may be Deleterious after Head InjuryThe Journal of Trauma and Acute Care Surgery, 1997
- ‘DAMAGE CONTROL'The Journal of Trauma and Acute Care Surgery, 1993
- PRIMARY INTRAMEDULLARY FEMUR FIXATION IN MULTIPLE TRAUMA PATIENTS WITH ASSOCIATED LUNG CONTUSION—A CAUSE OF POSTTRAUMATIC ARDS?The Journal of Trauma and Acute Care Surgery, 1993
- PACKING AND RE-EXPLORATION FOR PATIENTS WITH NONHEPATIC INJURIESThe Journal of Trauma and Acute Care Surgery, 1992
- Effect of associated injuries and blood volume replacement on death, rehabilitation needs, and disability in blunt traumatic brain injuryCritical Care Medicine, 1991
- The Management of Flail Chest InjuryThe Journal of Trauma and Acute Care Surgery, 1990
- Blunt Multiple Trauma (ISS 36), Femur Traction, and the Pulmonary Failure-Septic StateAnnals of Surgery, 1985