title: Are bilateral femoral fractures no longer a marker for death?
abstract: OBJECTIVE
  To determine whether previously reported high mortality rates associated with bilateral femoral fractures have decreased over time.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Urban academic trauma center.
  
  
  METHODS
  
  
  
  METHODS
  54 adults with bilateral femoral fractures treated at our center from 2000 to 2006. The 108 fractures were initially treated with external fixation (11%), reamed antegrade nailing (23%), and reamed retrograde nailing (67%). Unilateral control group: 461 patients with unilateral femoral fractures treated at our center from 2002 to 2005.
  
  
  METHODS
  Univariate analysis compared our results with those of a published historical control group from the same center approximately 15 years ago (study period, 1984-1990).
  
  
  METHODS
  Mortality rates.
  
  
  RESULTS
  We noted marked differences between the current mortality rate associated with bilateral femoral fractures and that of the historical control group. The mortality rate decreased over time at our center for both bilateral (26%-7%, P = 0.002) and unilateral (12%-2%, P = 0.0001) fractures. Mortality rates were still significantly higher (P = 0.037) for bilateral (7%) than for unilateral (2%) fractures.
  
  
  CONCLUSIONS
  Mortality rates and Injury Severity Scores were reduced for bilateral and unilateral femoral fractures compared with data reported 15 years ago from the same center. The improved outcome might be related in part to changes in resuscitation, triage, intensive care, and orthopaedic management of the patients. However, considering that the Injury Severity Score also significantly decreased, the improvement might have occurred because of changes in injury patterns, perhaps secondary to improved safety features in motor vehicles.
  
  
  METHODS
  Prognostic level III. See instructions for authors for a complete description of levels of evidence.
authors: *R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD; †Department of Orthopaedics, Johns Hopkins University, Baltimore, MD; and ‡Penn State Hershey Bone and Joint Institute, Hershey, PA.
authors: Robert V
authors: RV
authors: OʼToole
authors: Benjamin J
authors: BJ
authors: Lindbloom
authors: Emily
authors: E
authors: Hui
authors: Amelia
authors: A
authors: Fiastro
authors: Henry
authors: H
authors: Boateng
authors: Michael
authors: M
authors: OʼBrien
authors: Latasha
authors: L
authors: Murphy
authors: Carol E
authors: CE
authors: Copeland
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D005260:Female; D005264:Femoral Fractures / Q000401:mortality* / Q000601:surgery; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D014193:Trauma Centers; D014505:Urban Population