title: Are we prepared for orthopedic trauma surgery outside normal working hours? A retrospective analysis.
abstract: BACKGROUND
  This retrospective analysis was done to determine whether there is a change in outcomes of trauma patients undergoing intramedullary nailing (IMN) for femur and tibia fracture as an emergency versus elective procedure.
  
  
  METHODS
  Data were collected for all patients admitted to male orthopedic wards between 1 January 2004 and 30 June 2009 with femur and tibia fractures that required IMN. The data collected included surgery undertaken on as emergency or elective procedure, duration of surgery, complications encountered, and union status of fracture.
  
  
  RESULTS
  There were 431 fractures of the tibia, fibula and femur. Operating time for femur fracture as an emergency procedure was significantly greater than for elective surgery (191±79 versus 155±65 minutes; p≤0.001, confidence interval [CI] -19.54). For tibia fracture, operating times were 167.1±62 versus 69.2±35 minutes (p<0.001, CI <-85.4). Complications of infection, secondary surgery and of union were more common in emergency procedures than elective surgeries.
  
  
  CONCLUSIONS
  This study shows that complications are higher in emergency surgery than elective surgery due to the increase in the duration of surgery. This is attributed to the non-availability of dedicated trained orthopedic nursing staff and theater during emergency procedures. We believe that it is time to develop dedicated orthopedic trauma theaters in hospitals that treat emergency fracture fixations.
authors.affiliation: College of Medicine, University of Dammam, King Fahd Hospital of the University, Alkhobar, Saudi Arabia.
authors.forename: Mansour A
authors.initials: MA
authors.lastname: Al-Saflan
authors.forename: Mohammed Q
authors.initials: MQ
authors.lastname: Azam
authors.forename: Mir
authors.initials: M
authors.lastname: Sadat-Ali
mesh_terms: D000293:Adolescent; D000328:Adult; D017558:Elective Surgical Procedures / Q000592:standards / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000592:standards / Q000706:statistics & numerical data; D005264:Femoral Fractures / Q000601:surgery*; D005360:Fibula / Q000293:injuries; D005594:Fracture Fixation, Intramedullary / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D050723:Fractures, Bone / Q000601:surgery; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012529:Saudi Arabia; D013978:Tibial Fractures / Q000601:surgery*; D013997:Time Factors; D055815:Young Adult