Bilateral femoral fractures: Does intramedullary nailing increase systemic complications and mortality rates?

Stavlas, Panagiotis; Giannoudis, Peter V.

doi:10.1016/j.injury.2009.09.016

Cited by 20 publications

(11 citation statements)

References 58 publications

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“…Although there is controversy regarding the effect of intramedullary nailing on postoperative pulmonary function, the incidence of postoperative pulmonary complications including ARDS, pulmonary dysfunction, fat emboli, pulmonary embolism, and pneumonia have been estimated to be 4% to 38% among patients with femoral fractures in the presence of multiple injuries17). In particular, the incidence of postoperative ARDS has been reported as 2% to 15% after intramedullary nailing for the treatment of femur fracture1819). For this reason, the use of intramedullary nailing for the treatment of subtrochanteric fracture is limited in such cases.…”

Section: Discussionmentioning

confidence: 99%

Surgical Outcomes of Biologic Fixation for Subtrochanteric Fracture Using Locking Compression Plates

Jang

Ahn²,

Lee

et al. 2017

Hip & Pelvis

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PurposeThis study aimed to evaluate the surgical outcomes of biologic plating using locking compression plate-distal femur (LCP-DF) in patients with subtrochanteric fracture of the femur.Materials and MethodsBetween January 2010 and December 2013, 28 consecutive patients with subtrochanteric fractures of the femur, treated with biologic fixation using LCP-DF, were enrolled. Preoperative values, including patient age, sex, body mass index, fracture type, type of lung injury, and surgical timing from injury to surgery, were retrospectively evaluated. Radiologic assessments included time to union, coronal alignment, rotational alignment, and complications such as implant breakage and screw breakage. Adverse events, including postoperative fat embolism and adult respiratory distress syndrome, infection during the follow-up period, and walking ability at the last follow-up visit, were assessed.ResultsUnion was achieved in 27 patients (96.4%) after a mean duration of 5.4 months (range, 3-14 months). No patients developed fat embolism or adult respiratory distress syndrome during the hospitalization period of this study.ConclusionBiologic fixation using locking compression plates may represent a safe surgical option which can be utilized in patients with subtrochanteric fracture regardless of injury severity, surgical timing, fracture type, and presence of lung injury.

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Section: Discussionmentioning

confidence: 99%

Surgical Outcomes of Biologic Fixation for Subtrochanteric Fracture Using Locking Compression Plates

Jang

Ahn²,

Lee

et al. 2017

Hip & Pelvis

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“…8,9, 13,23 Although 88% of the patients who underwent definitive stabilization of femoral fractures within 24 hours did not have complications, multiple organ failure could be mitigated in severely injured patients by incorporating damage control tactics to minimize systemic inflammation. 4,10,12,14,[24][25][26] This approach appears most important in patients who are insufficiently resuscitated. 13,24,[26][27][28] In addition, patients with associated unstable pelvic ring or spine fractures may be not be suitable candidates for early definitive fixa-tion.…”

Section: Discussionmentioning

confidence: 99%

“…4,7 Early definitive fixation of femoral shaft fractures can be associated with greater rates of complications and multiple organ failure in patients who are insufficiently resuscitated to tolerate definitive surgical procedures. [12][13][14][15] The potential for morbidity and mortality is even greater with bilateral femur fractures because more initial bleeding and longer surgical times are anticipated compared with unilateral injury. Some institutions have adopted protocols for patients who have fractures and multiple system trauma.…”

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confidence: 99%

Morbidity and Mortality of Bilateral Femur Fractures

Lane¹,

Nahm²,

Vallier³

2015

Orthopedics

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Bilateral femur fractures have been associated with frequent morbidity and mortality. Associated injuries and massive hemorrhage contributed to mortality rates that were as high as 27% in previous reports. The goals of this study were to determine the frequency of associated complications, including mortality, and to identify which patient and injury features are associated with increased morbidity and mortality. The authors proposed that some patients with bilateral femur fractures may undergo early definitive fixation with an acceptable rate of complications. Patients who had bilateral femur fractures during the same injury event were retrospectively reviewed. Demographic characteristics, associated injuries, and the type and timing of treatment were determined. Complications were identified. The authors identified 50 men and 22 women, with a mean age of 41.5 years, who had high-energy bilateral femur fractures. These patients accounted for 5.5% of all femur fractures treated at the authors' institution over a period of 11 years. Two patients died before fixation. In addition, 13 other patients (19%) had 21 complications, including pneumonia in 6 (8.6%) and deep venous thrombosis in 7 (10%). No patient had adult respiratory distress syndrome, but 2 died of multiple organ failure. All patients with pulmonary complications had an underlying chest injury (P=.004). The overall mortality rate was 6.9%, and mortality was associated with higher mean age and higher Injury Severity Score (ISS). Of the 60 patients who had definitive fixation within 24 hours of injury, 53 (88%) had no complications. Complication rates were similar to those reported in the literature, with a mortality rate of 6.9%, including 3 patients who died after femoral fixation. Mortality was associated with advanced age and higher ISS. Chest injuries were associated with pulmonary complications. Most patients had early definitive fixation without complications, but it is not possible to predict which patients may be safely treated on an early basis.

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“…Bilateral femoral shaft fractures are a rare but serious injury, with an incidence of 1%-7% and mortality rate of 6%-32%. [1][2][3][4][5][6][7][8][9][10][11][12] Optimal management for patients sustaining bilateral femoral shaft fractures has been an area of interest and controversy. [1][2][3][4][5][6][7][8][9][10][11][12] Initial standard of care for polytrauma patients involved definitive fixation of all orthopaedic injuries.…”

Section: Introductionmentioning

confidence: 99%

Single-Stage Versus 2-Stage Bilateral Intramedullary Nail Fixation in Patients With Bilateral Femur Fractures: A Multicenter Retrospective Review

Flagstad

MacCormick

Heare

et al. 2021

Journal of Orthopaedic Trauma

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Bilateral femoral fractures: Does intramedullary nailing increase systemic complications and mortality rates?

Cited by 20 publications

References 58 publications

Surgical Outcomes of Biologic Fixation for Subtrochanteric Fracture Using Locking Compression Plates

Surgical Outcomes of Biologic Fixation for Subtrochanteric Fracture Using Locking Compression Plates

Morbidity and Mortality of Bilateral Femur Fractures

Single-Stage Versus 2-Stage Bilateral Intramedullary Nail Fixation in Patients With Bilateral Femur Fractures: A Multicenter Retrospective Review

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