Authors:
Hans-Christoph Pape, MD; Dieter Rixen, MD; Elisabeth Ellingsen Husbye, MD;
Michael Mueller, MD; Clemens Dumont, MD; Christian Krettek, MD;
Peter Giannoudis, MD; Peter Epoff, MD
Summary:
Objectives: The timing of definitive fixation for major fractures in polytrauma patients is
controversial. To address this gap, we randomized patients with blunt multiple injuries to
either initial definitive stabilization of the femur shaft with an intramedullary nail or an
external fixator and documented the postoperative clinical condition.
Methods: Multiply injured patients with femoral shaft fractures were randomized to either initial (<24 hours) intramedullary femoral nailing or external fixation and later conversion to an intramedullary nail. Inclusion criteria were new injury severity score (NISS) > 6 points, or three fractures and abbreviated injury scale (AIS) ≥2 points and another injury (AIS ≥2 points), and age 8 to 65 years. We excluded patients in unstable or critical condition. Patients were graded as stable or borderline (increased risk of systemic complications). Outcomes were the incidence of acute lung injuries.
Results: From 0 European centers, we had 65 patients with a mean age of 32.7 ± .7 years. The intramedullary nailing group was n = 94; the external fixation group, n = 71.
Preoperatively, 2 patients were stable and 44 patients were in borderline condition. After adjusting for differences in initial injury severity across the two treatment groups, the odds of developing acute lung injury were 6.69 times greater in borderline patients who underwent intramedullary nailing in comparison to those who underwent external fixation (P <.05).
Conclusion: Intramedullary stabilization of the femur fracture in borderline patients is associated with a higher incidence of lung dysfunction following primary nailing when compared with external fixation. Therefore, the preoperative condition should be considered for the decision making regarding the type of initial fixation for femoral fractures in patients with blunt multiple injuries.
Source:
Presented at the 23rd Annual Meeting of the Orthopaedic Trauma Association. Oct. 17-20, 2007. Boston. Conference final program, Page 104, Thurs., 10/18/07 Polytrauma, Paper #8, 2:21 pm