In-hospital mortality from femoral shaft fracture depends on the initial delay to fracture fixation and Injury Severity Score

Abstract

BACKGROUND Optimal surgical timing for definitive treatment of femur fractures in severely injured patients remains controversial. This study was performed to examine in-hospital mortality for patients with femur fractures with regard to surgical timing, Injury Severity Score (ISS), and age. METHODS The National Trauma Data Bank version 7.0 was used to evaluate in-hospital mortality for patients presenting with unilateral femur fractures. Patients were stratified into four groups by surgical timing (ST) and four groups by ISS. χ2 tests were used to evaluate baseline interrelationships. Binary regression was used to examine the association between time to surgery, ISS score, age, and mortality after adjusting for patient medical comorbidities, and personal demographics. RESULTS A total of 7,540 patients met inclusion criteria, with a 1.4% overall in-hospital mortality rate. For patients with an isolated femur fracture, surgical delay beyond 48 hours was associated with nearly five times greater mortality risk compared with surgery within 12 hours (adjusted relative risk, 4.8; 95% confidence interval, 1.6–14.1). Only severely injured patients (ISS, 26+) had higher associated mortality with no delay in surgical fixation (ST 1 < 12 hours) relative to ST2 of 13 hours to 24 hours with an adjusted relative risk of 4.2 (95% confidence interval, 1.0–16.7). The association between higher mortality rates and surgical delay beyond 48 hours was even stronger in the elderly patients. CONCLUSION This study supports the work of previous authors who reported that early definitive fixation of femur fractures is not only beneficial, particularly in the elderly, but also consistent with more recent studies recommending at least 12-hour to 24-hour delay in fixation in severely injured patients to promote better resuscitation. (J Trauma Acute Care Surg. 2014;00: 00–00. Copyright * 2014 by Lippincott Williams & Wilkins) LEVEL OF EVIDENCE Level II.

Complete Sciatic Nerve Transection Associated with a Closed Femoral Shaft Fracture

“…In high-income countries the annual incidence of femoral shaft fractures ranges between 8.2 and 23.9 per 100,000 people. Due to the high-energy mechanism, associated injuries are common in this patient population and the inhospital mortality has been reported to be approximately 1.4% [1][2][3]. In particular, musculoskeletal injuries to the ipsilateral limb, such as hip fractures, patella fractures, tibial plateau fractures, and ligamentous knee injuries have been reported to commonly occur in conjunction with high-energy femoral shaft fracture.…”

Disponibilidade de materiais para o tratamento das fraturas diafisárias do fêmur / Availability of materials for femoral shaft fractures fixation in Brazil

“…Para os próprios entrevistados a solução para este problema seria o maior investimento na quantidade e qualidade dos materiais. As repercussões da não realização deste procedimento imediatamente após a chegada ao serviço são: prolongamento do tempo de internação, maiores gastos hospitalares e maiores riscos de complicações sistêmicas inerentes às fraturas de ossos longos (10,(15)(16) .…”

Time to Surgery and Injury Severity Score

“…In this study, elective surgery is almost all orthopedic surgery (74%). Cantu et al (10) reported that patients with multiple injuries will likely benefit from resuscitation before definitive stabilization of femur fractures, but early fixation after resuscitation is important. Thus early elective surgery may have to be considered after the emergent operation when the patient is recovered.…”