Pulmonary and Cardiovascular Consequences of Immediate Fixation or Conservative Management of Long-Bone Fractures

Lozman, Jeffrey

doi:10.1001/archsurg.1986.01400090018003

Cited by 67 publications

(18 citation statements)

References 31 publications

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“…To our knowledge, only two prospective, randomized, controlled studies address the timing of fixation of femoral fractures in multiply injured patients. Both studies favored the early use of IMN in these patients: Bone et al 1 reported beneficial aspects of early fixation of femoral fractures and similar results were presented by Lozman et al 26 The effects of IMN have been studied in animal experiments. Neudeck et al noted that IMN adversely affects pulmonary function.…”

Section: Discussionmentioning

confidence: 62%

Early Unreamed Intramedullary Nailing of Femoral Fractures is Safe in Patients With Severe Thoracic Trauma

Weninger¹,

Figl²,

Spitaler³

et al. 2007

Journal of Trauma: Injury, Infection &Amp; Critical Care

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Section: Discussionmentioning

confidence: 62%

Early Unreamed Intramedullary Nailing of Femoral Fractures is Safe in Patients With Severe Thoracic Trauma

Weninger¹,

Figl²,

Spitaler³

et al. 2007

Journal of Trauma: Injury, Infection &Amp; Critical Care

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“…However, the large number of patients in the database improves the power of the study, 32 and even prospective studies on timing of fixation have led tovarying conclusions. Lozman et al 33 in 1986 found improved cardiac index and lower shunting with immediate fixation in patients with femoral or tibial fractures randomized to immediate fixation versus traction or plaster casts and concluded that there was less pulmonary dysfunction with immediate fixation. In contrast, in a prospective evaluation using damage-control orthopedics for patients with multiple injuries, Taeger et al 34 reported a 19.3% reduction in mortality compared with what would have been expected based on ISSs.…”

Section: Discussionmentioning

confidence: 99%

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

Cantu

Graves

Spratt

2014

Journal of Trauma and Acute Care Surgery

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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.

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“…Another study done by Bone et al found a high rate of pulmonary complications in patients who had delayed stabilization of fractures [2]. Lozman et al demonstrated better cardiac function in patients undergoing immediate fracture fixation [3] and Pape et al found that early intramedullary nail was associated with a significantly lower ventilation time and total intensive care stay, as compared to patients undergoing secondary stabilization [4].…”

Section: Discussionmentioning

confidence: 99%

Damage control orthopedics in a patient with polytrauma complicated with thyroid storm

Manikam¹,

Emmed²,

Kumar³

et al. 2013

IJCRI

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International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. Case Report: Presenting a case of a polytrauma patient with thyroid storm. The decision on DCO in this patient being discussed. Conclusion:The decision about the timing of surgery should be based on the patients' condition as a whole. Careful planning and definition of priorities in each individual patient is essential. This holistic approach will see that patient safety care improves.

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Pulmonary and Cardiovascular Consequences of Immediate Fixation or Conservative Management of Long-Bone Fractures

Cited by 67 publications

References 31 publications

Early Unreamed Intramedullary Nailing of Femoral Fractures is Safe in Patients With Severe Thoracic Trauma

Early Unreamed Intramedullary Nailing of Femoral Fractures is Safe in Patients With Severe Thoracic Trauma

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

Damage control orthopedics in a patient with polytrauma complicated with thyroid storm

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