title: Retrograde intramedullary nailing in treatment of bilateral femur fractures.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the use of retrograde nailing to treat patients with bilateral femur fractures.
  
  
  METHODS
  A retrospective review of prospectively obtained trauma databases was completed at 9 Level 1 trauma centers.
  
  
  METHODS
  In all, 3767 patients with femur fractures were identified. Of those, 89 (46 males, 43 females) had bilateral femur fractures treated with reamed, retrograde intramedullary nails within 48 hours after injury. The charts were reviewed for pertinent data.
  
  
  RESULTS
  The average cohort age was 30 years (16-63 years). The average Injury Severity Score was 21 (9-50). Eighty-five patients (96%) had associated injuries. Thirteen patients (14.6%) developed adult respiratory distress syndrome; 8 had thoracic injuries. There were 4 patients (4%) with fat embolism syndrome, 2 were delayed longer than 24 hours to the operating room. There were 5 deaths (5.6% mortality) in the retrograde nailing group. Thoracic injury was found to be associated with death rate (P < 0.07).
  
  
  CONCLUSIONS
  Bilateral femur fractures are indicative of severe injuries with mortality rates as high as 40%. There are no specific studies addressing the outcomes of bilateral femur fractures treated with retrograde nailing. In this largest retrospective study to date, the overall death rate of 5.6% was significantly lower than historical controls. The effect of timing and duration of surgery and other injuries is not completely known. In conclusion, retrograde nailing of bilateral femur fractures is an acceptable treatment for bilateral femur fractures.
authors.affiliation: Department of Orthopaedic Surgery, The University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390-8883, USA. jcannada@aol.com
authors.forename: Lisa K
authors.initials: LK
authors.lastname: Cannada
authors.forename: Sascha
authors.initials: S
authors.lastname: Taghizadeh
authors.forename: Jothi
authors.initials: J
authors.lastname: Murali
authors.forename: William T
authors.initials: WT
authors.lastname: Obremskey
authors.forename: Charles
authors.initials: C
authors.lastname: DeCook
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bosse