OTA 1997 Posters - Trauma Issues

Optimal Timing of Early Femoral Fracture Fixation in Multiply Injured Trauma Patients

Emil H. Schemitsch, MD, FRCS(C), Peter Evans, MD, Theresa Brown, RN, Michael D. McKee, MD, FRCS(C), James P. Waddell, MD, FRCS(C)

St. Michael's Hospital, Univ. of Toronto, Toronto, Ontario, Canada

Purpose: To determine whether the time to fixation has an effect on the outcome of trauma patients with femoral fractures fixed within 24 hours of injury.

Conclusion: The time to fixation did not affect the outcome of trauma patients with femoral fractures alone or in combination with pulmonary contusions when fixed within 24 hours of injury. The presence of a pulmonary contusion increased the number of subsequent pulmonary complications.

Significance: In trauma patients with femur fractures alone or in combination with pulmonary contusions, outcome is less related to the timing of fixation in the first 24 hours than to the presence of a pulmonary contusion.

Discussion: The records of 231 trauma patients (180 with ISS 16) with femoral fractures who had been entered into a prospective trauma database over an 8 year period from 1987 to 1995 were reviewed. Patients with hip or condyle fractures or fixation performed greater than 24 hours were excluded. The age, sex, days ventilated, days in ICU, days in Step-down Unit, blood product usage, Abbreviated Injury Score, Injury Severity Score, and outcome (survival or death, pulmonary complications [fat embolism syndrome, adult respiratory distress syndrome, pulmonary dysfunction, abnormal ABG'S, pulmonary embolus, pneumothorax and pneumonia]) of each patient were recorded. The presence of a pulmonary contusion was defined using the criteria of the Abbreviated Injury Score. There were 96 males and 56 females, with a mean age of 32 years. The mean ISS was 24.2. There were 19 deaths so that the overall survival rate was 88.9%. Forty-seven patients had sustained an associated pulmonary contusion. In the surviving patients, timing to fracture fixation was divided into 0-6 hours (mean = 4.1 hours, n=79), 6-12 hours (mean = 8.3 hours, n=48) and 12-24 hours (mean = 16.6 hours, n=25). ISS was the same in each time group. Timing to fracture fixation did not affect mortality, disposition, number of pulmonary complications and blood product usage in femur fracture patients with or without an associated pulmonary contusion (p=NS). However, the presence of a pulmonary contusion was associated with a statistically greater number of pulmonary complications (p=0.01), mechanical ventilator and ICU days (p<0.05). In trauma patients with femur fractures alone or in comblnation with pulmonary contusions, outcome is less related to the timing of fixation in the first 24 hours than to the presence of a pulmonary contusion.