title: Safety and efficacy of damage control external fixation versus early definitive stabilization for femoral shaft fractures in the multiple-injured patient.
abstract: BACKGROUND
  Optimal timing and treatment of patients with concomitant head, thoracic, or abdominal injury and femoral shaft fracture remain controversial. This study examines acute patient outcomes associated with early total care with intramedullary nailing (ETC group) versus damage control external fixation (DCO group) for multiple-injured patients with femoral shaft fractures. We propose DCO as a safe initial treatment for the multiple-injured patient with femur shaft fractures.
  
  
  METHODS
  This study was a retrospective review of the trauma registry and multisystem organ failure registry data at a Level I trauma center. Two cohorts were identified to compare multiple-injured patients with femoral shaft fractures treated with early total care and damage control orthopaedic surgery. Primary outcome measures included mortality, pulmonary complications (adult respiratory distress syndrome [ARDS] score), transfusion requirements, and multiple organ failure (MOF score). Operative time, estimated blood loss, intensive care unit length of stay (LOS), and hospital length of stay (LOS) were also compared.
  
  
  RESULTS
  During the study period, 462 patients with 481 femoral shaft fractures were identified. Of 462 patients with femoral shaft fractures, 97 met the inclusion criteria (42 ETC and 55 DCO). The DCO group had a significantly shorter operative time (22 minutes vs. 125 minutes) and less estimated blood loss from their operative procedure (37 mL vs. 330 mL). There was no significant difference between the groups for ARDS, lung scores, MOF, MOF score, intensive care unit LOS, or hospital LOS.
  
  
  CONCLUSIONS
  Fracture fixation method did not have an impact on the incidence of systemic complications in multiple-injured patients with femoral shaft fractures. Although minimal differences were noted between DCO and ETC groups regarding systemic complications, DCO is a safer initial approach, significantly decreasing the initial operative exposure and blood loss.
authors.affiliation: Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado Health Sciences Center, Denver, Colorado 80204, USA.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Tuttle
authors.forename: Wade R
authors.initials: WR
authors.lastname: Smith
authors.forename: Allison E
authors.initials: AE
authors.lastname: Williams
authors.forename: Juan F
authors.initials: JF
authors.lastname: Agudelo
authors.forename: Cody J
authors.initials: CJ
authors.lastname: Hartshorn
authors.forename: Ernest E
authors.initials: EE
authors.lastname: Moore
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Morgan
mesh_terms: D000328:Adult; D015331:Cohort Studies; D016267:External Fixators; D005260:Female; D005264:Femoral Fractures / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects; D006801:Humans; D007902:Length of Stay; D008297:Male; D009102:Multiple Organ Failure / Q000453:epidemiology; D009104:Multiple Trauma / Q000401:mortality / Q000601:surgery*; D012128:Respiratory Distress Syndrome / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome