title: Mortality after reamed intramedullary nailing of bilateral femur fractures.
abstract: We performed retrospective review of 743 patients treated with reamed intramedullary nailing of a femoral shaft fracture was done to assess the clinical impact of bilateral femur fractures on the mortality, hospital stay, and length of intensive care treatment in patients with blunt trauma. Unilateral injuries occurred in 689 patients and bilateral injuries occurred in 54 patients. Mortality in patients with bilateral femur fractures was 5.6% compared with 1.5% in patients with unilateral femur fractures. The two groups were analyzed using multiple linear regression and logistic regression with age and Injury Severity Scores as covariants to allow for comparison of similarly injured groups as predicted by the Injury Severity Scores. Bilateral femur fractures still were associated with a significantly higher mortality, longer length of stay in the hospital, and longer length of stay in the intensive care unit. As expected, when analyzed separately, patients with bilateral femur fractures had significantly higher Injury Severity Scores, longer lengths of stay in the intensive care unit, and longer lengths of stay in the hospital. Patients with bilateral femur fractures have an increased mortality when compared with patients with unilateral femur fractures after controlling for Injury Severity Score and age. When used alone, the Injury Severity Score underestimates the contribution of a second femur fracture.
authors: Harborview Medical Center, Department of Orthopaedic Surgery, Box 359798, 325 Ninth Avenue, Seattle, WA 98104-2499, USA.
authors: Sean E
authors: SE
authors: Nork
authors: Julie
authors: J
authors: Agel
authors: George V
authors: GV
authors: Russell
authors: William J
authors: WJ
authors: Mills
authors: Sarah
authors: S
authors: Holt
authors: M L Chip
authors: ML
authors: Routt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005264:Femoral Fractures / Q000209:etiology / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000379:methods / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000209:etiology / Q000601:surgery*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D014193:Trauma Centers; D016896:Treatment Outcome; D014861:Washington / Q000453:epidemiology; D014949:Wounds, Nonpenetrating / Q000150:complications*