title: The effect of a femoral fracture on concomitant closed head injury in patients with multiple injuries.
abstract: OBJECTIVE
  We sought to determine the effect of a femoral shaft fracture, and its treatment by early intramedullary nailing, on the neurologic outcome of patients with multiple injuries with a concomitant head injury.
  
  
  METHODS
  Retrospective, case-control design using a prospectively gathered trauma data base.
  
  
  METHODS
  We identified 46 patients with multiple injuries (mean Injury Severity Score [ISS] = 33.2) with closed head injuries (mean Glasgow Coma Scale [GCS] score = 7.8) and femur fractures, and matched as controls 99 patients with multiple injuries with head injuries but without femur fractures for age, sex, mechanism of injury, ISS (mean ISS = 34.0), and GCS (mean GCS score = 8.0). Follow-up parameters examined included early mortality, length of hospital or intensive-care unit stay, neuropsychological testing, and level of neurologic disability.
  
  
  RESULTS
  There were no significant differences in the demographics or injury parameters between the study and control groups. There were no significant differences between the two groups in terms of early mortality (study group, 28%; control group, 27%; p = not significant), length of hospital/intensive-care unit stay (study group, 17.5/6.9 days; control group, 18.0/6.3 days; p = not significant), level of neurologic disability, or results of cognitive testing.
  
  
  CONCLUSIONS
  Our study suggests that a femoral fracture in a patient with a concomitant head injury does not increase mortality or neurologic disability, and supports the continued early intramedullary nailing of femoral fractures for these patients.
authors.affiliation: Division of Orthopaedic Surgery, St. Michael's Hospital and the University of Toronto, Ontario, Canada.
authors.forename: M D
authors.initials: MD
authors.lastname: McKee
authors.forename: E H
authors.initials: EH
authors.lastname: Schemitsch
authors.forename: L O
authors.initials: LO
authors.lastname: Vincent
authors.forename: I
authors.initials: I
authors.lastname: Sullivan
authors.forename: D
authors.initials: D
authors.lastname: Yoo
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005264:Femoral Fractures / Q000150:complications* / Q000601:surgery; D005594:Fracture Fixation, Intramedullary; D015600:Glasgow Coma Scale; D016489:Head Injuries, Closed / Q000150:complications* / Q000401:mortality; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000401:mortality; D009483:Neuropsychological Tests; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors