title: Prediction of pulmonary morbidity and mortality in patients with femur fracture.
abstract: BACKGROUND
  We aimed to determine the effect of femur fractures on mortality, pulmonary complications, and adult respiratory distress syndrome (ARDS). In addition, we aimed to compare the effect of femur fractures with other major musculoskeletal injuries and to determine the effect of timing to surgery on these complications.
  
  
  METHODS
  All patients were identified from the trauma registries of two Level I trauma centers. Outcomes were defined at mortality in hospital, pulmonary complications, and ARDS in hospital. Regression analysis was used to determine the effect of femur fractures, while controlling for age, Abbreviated Injury Scales, Glasgow Coma Scale, and systolic blood pressure at presentation. We compared femur fractures with other major musculoskeletal injuries in similar models. Within the patients with femur fracture, time to surgery (< 8 hours, 8 hours to 24 hours, and > 24 hours) was evaluated using similar regression analysis.
  
  
  RESULTS
  Of the total 90,510 patients, 3,938 (4.35%) died in the hospital, 2,055 (2.27%) had a pulmonary complication, and 285 (0.31%) developed ARDS. Femur fracture is statistically predictive of mortality (odds ratio [OR], 1.606; 95% confidence interval [CI], 1.288-2.002) and pulmonary complications (OR, 1.659; 95% CI, 1.329-2.070), when controlling for other injury factors. This was comparable with the effect of pelvic fracture and other major musculoskeletal injuries. Femur fracture had a strong relationship with ARDS (OR, 2.129; 95% CI, 1.382-3.278). Patients treated in the 8 hours to 24 hours window had the lowest mortality risk (OR, 0.140; 95% CI, 0.052-0.375), and there was a trend to increased risk of ARDS in a delay to surgery of > 24 hours.
  
  
  CONCLUSIONS
  Femur fractures are a major musculoskeletal injury and increase the risk of mortality and pulmonary complications as much as any other musculoskeletal injuries. There is a unique relationship between ARDS and femur fractures, and this must be considered carefully in treatment planning for these patients.
authors.affiliation: Department of Orthopaedic Surgery, University of British Columbia, Vancouver, British Columbia, Canada. kelly.lefaivre@vch.ca
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Lefaivre
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Starr
authors.forename: Philip F
authors.initials: PF
authors.lastname: Stahel
authors.forename: Alan C
authors.initials: AC
authors.lastname: Elliott
authors.forename: Wade R
authors.initials: WR
authors.lastname: Smith
mesh_terms: D015998:Abbreviated Injury Scale; D000328:Adult; D000368:Aged; D001794:Blood Pressure; D005260:Female; D005264:Femoral Fractures / Q000150:complications*; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D008171:Lung Diseases / Q000209:etiology* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000401:mortality