title: Use of femoral shaft fracture classification for predicting the risk of associated injuries.
abstract: OBJECTIVE
  To investigate the hypothesis that specific fracture patterns in patients with femoral shaft fractures can predict the likelihood of associated injuries.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Level I trauma center.
  
  
  METHODS
  Consecutive patients treated because of a traumatic diaphyseal femoral fracture.
  
  
  METHODS
  We studied the association between the Orthopaedic Trauma Association (OTA) fracture classification (derived from initial radiographs) and concomitant injuries of the head, spine, chest, abdomen, and pelvis with a severity of two or more points according to the Abbreviated Injury Scale by logistic regression analysis.
  
  
  RESULTS
  One hundred forty-three of 203 patients (80 men, 63 women; mean age 54 ± 26 years) met the inclusion criteria. All patients had unilateral diaphyseal fractures, 64 OTA 32.A (45%), 46 OTA 32.B (32%), and 33 OTA 32.C (23%). In addition, 134 associated injuries were identified in 52 patients. Increasing fracture severity, as expressed by the OTA classification (ie, A, B, C), was significantly associated with a higher likelihood of thoracic (odds ratio [OR], 5.89; 95% confidence interval [CI], 2.59-13.40), pelvic (OR, 4.55; 95% CI, 2.01-10.28), upper (OR, 2.38; 95% CI, 1.27-4.48), and lower extremity injuries (OR, 3.12; 95% CI, 1.78-5.46). Fracture severity explained between 70% and 86% of the probability of having accompanying injuries.
  
  
  CONCLUSIONS
  Radiographic grading of the severity of a femoral shaft fracture may signal the presence of accompanying injuries and should contribute to the clinical decision-making process in severe trauma.
authors.affiliation: Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds, UK.
authors.forename: Vassilios S
authors.initials: VS
authors.lastname: Nikolaou
authors.forename: Dirk
authors.initials: D
authors.lastname: Stengel
authors.forename: Peter
authors.initials: P
authors.lastname: Konings
authors.forename: George
authors.initials: G
authors.lastname: Kontakis
authors.forename: Gerasimos
authors.initials: G
authors.lastname: Petridis
authors.forename: Giannos
authors.initials: G
authors.lastname: Petrakakis
authors.forename: Peter V
authors.initials: PV
authors.lastname: Giannoudis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005264:Femoral Fractures / Q000145:classification / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000175:diagnosis* / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D014193:Trauma Centers; D055815:Young Adult