Thurs., 10/18/07 Polytrauma, Paper #11, 2:46 pm OTA-2007
Risk of Mortality: The Relationship of Associated Injuries and Fracture Treatment Methods in Patients with Unilateral or Bilateral Femoral Shaft Fractures
Keith M. Willett, FRCS1 (n); H. Al-Khateeb, MD1 (n); Rohit Kotnis, MD1 (n);
Omar Bouamra2 (n); Fiona Lecky, PhD2 (n);
1Trauma Unit, John Radcliffe Hospital, Oxford, United Kingdom;
2Trauma Audit Research Network, University of Manchester, United Kingdom
Background: Our objective was to determine the relative contributions of bilateral versus unilateral femoral shaft fracture plus injuries in other body regions to mortality after injury.
Study Design: This is a retrospective analysis of the prospectively recorded Trauma Registry data (TARN) from 1989 to 2003.
Methods: Patients were divided into groups UFi (isolated unilateral femur injury), BFi (isolated bilateral femur injury), and UFa and BFa if an associated injury was present. Data collected for each patient included: age, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), mortality, physiologic parameters, the timing and extent of prehospital care, the time to arrival at the hospital, initial treatments, time to surgery, and length of ICU and hospital stay. Logistic regression data analysis was performed to determine variables that were associated with increasing mortality.
Results: Patients in group BFa had a significantly higher ISS (23 vs 9), reduced GCS (12 vs 15), increased mortality rate (31.6% vs 9.8%,) and lower presenting mean systolic blood pressures (116 mmHg vs 135 mmHg) than patients in group BFi. Group BFa patients had an increased number of associated injuries than group UFa. Regression analysis of variables evident on admission revealed a significant correlation between bilateral femoral fractures with associated injuries and mortality. However, bilateral fracture, even in isolation, significantly increased the odds of mortality by 3.07 (1.36-6.92). Intramedullary nailing (IMN) was the method of fracture fixation associated with the lowest patient mortality overall; however, when assessing patient mortality in the BFa group with an ISS of >40, three other fracture fixation regimens were associated with a lower mortality rate than the IMN.
Conclusions: The increase in mortality with bilateral femoral fractures is more closely associated with the presence of associated injuries than to the presence of the bilateral femoral fracture alone. However, contrary to ISS scoring, the latter does convey a significant additional risk of mortality. The presence of bilateral femoral fractures should alert the clinician to the very high likelihood (80%) of significant associated injuries in other body systems and their life-threatening potential.
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