Delayed surgical fixation of femur fractures is a risk factor for pulmonary failure independent of thoracic trauma

William E. Charash, Timothy C. Fabian, Martin Croce

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Abstract

A recent retrospective analysis of femur fractures concluded that early surgical fixation in patients who have sustained blunt thoracic trauma (AIS score for Thorax ≥ 2) was a risk factor for postoperative pulmonary failure. We conducted a review of all femur fractures admitted to a level I trauma center from November, 1988 to May, 1993. Inclusion criteria were ISS ≥ 18, mid-shaft femur fractures treated with reamed intramedullary fixation, and no mortalities secondary to head trauma or hemorrhagic shock. One hundred thirty-eight patients met these criteria. Four patient groups were created: N1—no thoracic trauma (AIS score for thorax < 2), and early surgical fixation (<24 hours after injury, n = 49); N2—no thoracic trauma and delayed fixation (≥24 hours, n = 8); T1—thoracic trauma (AIS score for Thorax ≥ 2) and early fixation (n = 56); T2—thoracic trauma and delayed fixation (n = 25). There were no significant differences in age, Injury Severity Score, or Glasgow Coma Scale score between the four groups. Mortality rate, length of stay (LOS), LOS in the TICU, and duration of mechanical ventilation tended to be greater in patients with delayed fracture fixation, however, this was not statistically significant. The N2 patients had a pneumonia rate of 38% compared with 10% in group N1 (ρ = 0.07). The T2 patients had a pneumonia rate of 48% compared with 14% in group T1 (ρ = 0.002). The overall pulmonary complication rate (pneumonia, adult respiratory distress syndrome, fat embolism syndrome, and pulmonary embolus) was 56% in group T2 compared with 16% in group T1 (ρ = 0.007). We conclude that delayed surgical fixation is associated with a higher pulmonary complication rate, independent of blunt thoracic trauma.

Original languageEnglish (US)
Pages (from-to)667-672
Number of pages6
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume37
Issue number4
DOIs
StatePublished - Jan 1 1994

Fingerprint

Fracture Fixation
Femur
Thorax
Lung
Wounds and Injuries
Pneumonia
Length of Stay
Fat Embolism
Glasgow Coma Scale
Injury Severity Score
Hemorrhagic Shock
Mortality
Trauma Centers
Adult Respiratory Distress Syndrome
Embolism
Craniocerebral Trauma
Artificial Respiration

All Science Journal Classification (ASJC) codes

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Delayed surgical fixation of femur fractures is a risk factor for pulmonary failure independent of thoracic trauma. / Charash, William E.; Fabian, Timothy C.; Croce, Martin.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 37, No. 4, 01.01.1994, p. 667-672.

Research output: Contribution to journalArticle

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abstract = "A recent retrospective analysis of femur fractures concluded that early surgical fixation in patients who have sustained blunt thoracic trauma (AIS score for Thorax ≥ 2) was a risk factor for postoperative pulmonary failure. We conducted a review of all femur fractures admitted to a level I trauma center from November, 1988 to May, 1993. Inclusion criteria were ISS ≥ 18, mid-shaft femur fractures treated with reamed intramedullary fixation, and no mortalities secondary to head trauma or hemorrhagic shock. One hundred thirty-eight patients met these criteria. Four patient groups were created: N1—no thoracic trauma (AIS score for thorax < 2), and early surgical fixation (<24 hours after injury, n = 49); N2—no thoracic trauma and delayed fixation (≥24 hours, n = 8); T1—thoracic trauma (AIS score for Thorax ≥ 2) and early fixation (n = 56); T2—thoracic trauma and delayed fixation (n = 25). There were no significant differences in age, Injury Severity Score, or Glasgow Coma Scale score between the four groups. Mortality rate, length of stay (LOS), LOS in the TICU, and duration of mechanical ventilation tended to be greater in patients with delayed fracture fixation, however, this was not statistically significant. The N2 patients had a pneumonia rate of 38{\%} compared with 10{\%} in group N1 (ρ = 0.07). The T2 patients had a pneumonia rate of 48{\%} compared with 14{\%} in group T1 (ρ = 0.002). The overall pulmonary complication rate (pneumonia, adult respiratory distress syndrome, fat embolism syndrome, and pulmonary embolus) was 56{\%} in group T2 compared with 16{\%} in group T1 (ρ = 0.007). We conclude that delayed surgical fixation is associated with a higher pulmonary complication rate, independent of blunt thoracic trauma.",
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AB - A recent retrospective analysis of femur fractures concluded that early surgical fixation in patients who have sustained blunt thoracic trauma (AIS score for Thorax ≥ 2) was a risk factor for postoperative pulmonary failure. We conducted a review of all femur fractures admitted to a level I trauma center from November, 1988 to May, 1993. Inclusion criteria were ISS ≥ 18, mid-shaft femur fractures treated with reamed intramedullary fixation, and no mortalities secondary to head trauma or hemorrhagic shock. One hundred thirty-eight patients met these criteria. Four patient groups were created: N1—no thoracic trauma (AIS score for thorax < 2), and early surgical fixation (<24 hours after injury, n = 49); N2—no thoracic trauma and delayed fixation (≥24 hours, n = 8); T1—thoracic trauma (AIS score for Thorax ≥ 2) and early fixation (n = 56); T2—thoracic trauma and delayed fixation (n = 25). There were no significant differences in age, Injury Severity Score, or Glasgow Coma Scale score between the four groups. Mortality rate, length of stay (LOS), LOS in the TICU, and duration of mechanical ventilation tended to be greater in patients with delayed fracture fixation, however, this was not statistically significant. The N2 patients had a pneumonia rate of 38% compared with 10% in group N1 (ρ = 0.07). The T2 patients had a pneumonia rate of 48% compared with 14% in group T1 (ρ = 0.002). The overall pulmonary complication rate (pneumonia, adult respiratory distress syndrome, fat embolism syndrome, and pulmonary embolus) was 56% in group T2 compared with 16% in group T1 (ρ = 0.007). We conclude that delayed surgical fixation is associated with a higher pulmonary complication rate, independent of blunt thoracic trauma.

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