Sat., 10/16/10 Polytrauma & Femur, Paper #64, 10:00 am OTA-2010
Δ Early Appropriate Care: Definitive Stabilization of Femoral Fractures within 24 Hours of Injury Is Safe in Most Multiply-Injured Patients
Nickolas J. Nahm, BS; John J. Como, MD; John H. Wilber, MD; Heather A. Vallier, MD;
MetroHealth Medical Center, Cleveland, Ohio, USA
Purpose: Type and timing of treatment of femur fractures is controversial. While safe and effective in many reports, early definitive stabilization may be associated with complications, particularly in patients with chest and head injuries. Damage control orthopaedics was proposed as an alternative in unstable patients. This study examines the effects of timing of definitive fixation and investigates risk factors for complications.
Methods: 750 skeletally mature patients underwent stabilization of femur fractures. Their mean age was 35.8 years and mean injury severity score (ISS) 23.7. 492 patients had ISS ≥18. Early stabilization (n = 656) was defined as definitive treatment of the femur fracture within 24 hours of injury.
Results: Early definitive stabilization in multiply injured patients was associated with fewer complications than delayed stabilization (18.9% vs 42.9%, P < 0.037) after adjusting for patient age and ISS. Early treatment was also associated with shorter hospital stay, ICU stay, and ventilator days (P < 0.001). Severe abdominal injury (abbreviated injury scale [AIS] ≥3) was associated with more complications than severe head (Glasgow coma scale ≤8) and chest (AIS≥3) injuries (44.2%, 40.9%, and 34.4%, respectively) and was an independent risk factor for complications (P < 0.0001). Chest injury was an independent risk factor for pulmonary complications (P < 0.001), but surgical delay in chest-injured patients was also associated with pulmonary complications (P = 0.04). More sepsis was noted with severe head injury (22.7% vs 4.5%, P = 0.037) or severe chest injury (10.2% vs 2.5%, P = 0.044) when treated on a delayed basis. Patients transferred from other hospitals were more likely to be treated on a delayed basis (48.9% vs 37.5%, P = 0.04) despite similar injury severity.
Conclusions: Early definitive stabilization is associated with acceptably low rates of complications and is safe in most multiply injured patients, including some with severe abdominal, chest, or head injuries. More complications and longer hospital stay were noted with delayed fixation after adjusting for age and ISS. Chest injury was associated with pulmonary complications; however, the presence of severe abdominal injury was the greatest risk factor for complications, warranting further investigation. Expediting access to definitive care may reduce complications and expenses.
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• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.