title: Treatment of femur fracture with associated head injury.
abstract: OBJECTIVE
  The aim of this study was to determine (a) whether delay in femur fracture stabilization beyond twenty-four hours in patients with head injury increased the risk of pulmonary complications and (b) whether immediate (up to twenty-four hours) femur fracture stabilization increased the risk of central nervous system (CNS) complications.
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  Thirty-two patients with femur fracture and head injury were identified. Fourteen underwent immediate stabilization of their fractures, and eighteen underwent delayed (four-teen patients) or no (four patients) stabilization of their fractures.
  
  
  RESULTS
  In the immediate stabilization group, five patients had severe head injuries [Glasgow Coma Score (GCS) < or = 8] and nine had mild head injuries (GCS > 8). In the mild head injury group, no patient had a pulmonary complication and one had a CNS complication. In the severely head-injured group, one patient had a pulmonary complication and no patient had a CNS complication. In the delayed stabilization group, six patients had mild head injuries (GCS > 8) and twelve had severe head injuries (GCS < or = 8). In the mildly head injured group, one patient had a pulmonary complication, two patients had CNS complications, and one patient died. In the severely head injured group, nine patients had pulmonary complications, three patients had CNS complications, and one patient died. Logistic regression identified delay in femur stabilization as the strongest predictor of pulmonary complication (p = 0.0042), followed by severity of chest Abbreviated Injury Score (AIS; p = 0.0057) and head AIS (p = 0.0133). Delaying fracture stabilization made pulmonary complications forty-five times more likely. Each point increase in the chest AIS and head/neck AIS increased the risk of pulmonary complication by 300 percent and 500 percent, respectively. A statistically significant predictor of CNS complications could not be identified by using logistic regression.
  
  
  CONCLUSIONS
  Delay in stabilization of femur fracture in head-injured patients appears to increase the risk of pulmonary complications. However, due to selection bias in this patient sample, this question cannot be definitively answered. Early fracture stabilization did not increase the prevalence of CNS complications.
authors.affiliation: Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas 75235-8883, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Starr
authors.forename: J L
authors.initials: JL
authors.lastname: Hunt
authors.forename: D P
authors.initials: DP
authors.lastname: Chason
authors.forename: C M
authors.initials: CM
authors.lastname: Reinert
authors.forename: J
authors.initials: J
authors.lastname: Walker
mesh_terms: D000293:Adolescent; D000328:Adult; D002493:Central Nervous System Diseases / Q000209:etiology*; D005264:Femoral Fractures / Q000150:complications* / Q000601:surgery*; D015600:Glasgow Coma Scale; D016489:Head Injuries, Closed / Q000150:complications*; D006801:Humans; D008171:Lung Diseases / Q000209:etiology*; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications*; D012189:Retrospective Studies; D013997:Time Factors