title: Impact of the method of initial stabilization for femoral shaft fractures in patients with multiple injuries at risk for complications (borderline patients).
abstract: OBJECTIVE
  The timing of definitive fixation for major fractures in patients with multiple injuries 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 fixateur with later conversion to an intermedullary nail 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: New Injury Severity Score >16 points, or 3 fractures and Abbreviated Injury Scale score > or =2 points and another injury (Abbreviated Injury Scale score > or =2 points), and age 18 to 65 years. Exclusion: patients in unstable or critical condition. Patients were graded as stable or borderline (increased risk of systemic complications).
  
  
  RESULTS
  : Incidence of acute lung injuries.
  
  
  RESULTS
  Ten European Centers, 165 patients, mean age 32.7 +/- 11.7 years. Group intramedullary nailing, n = 94; group external fixation, n = 71. Preoperatively, 121 patients were stable and 44 patients were in borderline condition. After adjusting for differences in initial injury severity between the 2 treatment groups, the odds of developing acute lung injury were 6.69 times greater in borderline patients who underwent intramedullary nailing in comparison with those who underwent external fixation, P < 0.05.
  
  
  CONCLUSIONS
  Intramedullary stabilization of the femur fracture can affect the outcome in patients with multiple injuries. In stable patients, primary femoral nailing is associated with shorter ventilation time. In borderline patients, it is associated with a higher incidence of lung dysfunctions when compared with those who underwent external fixation and later conversion to intermedullary nail. Therefore, the preoperative condition should be when deciding on the type of initial fixation to perform in patients with multiple blunt injuries.
authors: Division of Trauma, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA. papehc@upmc.edu
authors: Hans-Christoph
authors: HC
authors: Pape
authors: Dieter
authors: D
authors: Rixen
authors: John
authors: J
authors: Morley
authors: Elisabeth Ellingsen
authors: EE
authors: Husebye
authors: Michael
authors: M
authors: Mueller
authors: Clemens
authors: C
authors: Dumont
authors: Andreas
authors: A
authors: Gruner
authors: Hans Joerg
authors: HJ
authors: Oestern
authors: Michael
authors: M
authors: Bayeff-Filoff
authors: Christina
authors: C
authors: Garving
authors: Dustin
authors: D
authors: Pardini
authors: Martijn
authors: M
authors: van Griensven
authors: Christian
authors: C
authors: Krettek
authors: Peter
authors: P
authors: Giannoudis
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D005260:Female; D005264:Femoral Fractures / Q000150:complications / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D017102:Fracture Healing; D006801:Humans; D008297:Male; D009104:Multiple Trauma; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D015599:Trauma Severity Indices; D016896:Treatment Outcome
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