Timing of diaphyseal femur fracture nailing: is the difference night and day?
BACKGROUND
Most hospitals are faced with reduced personnel, resources, and provider fatigue or shift changes when day turns to night. For these reasons, some have suggested that diaphyseal femur fractures should be fixed during the daytime. The purpose of this study is to determine whether the time of surgery affects the post-operative difference in femoral version (DFV) and femoral length (DFL) between the fixed and uninjured sides following intramedullary nailing (IMN).


METHODS
Over a 10-year period, 340 patients underwent IMN of a diaphyseal femur fracture (AO types 32-A to C) with a post-operative computed tomography scanogram for version measurement. Demographic and surgical data, including time operated was collected. "Daytime" was defined as 7:00 AM to 6:59 PM, while the remainder of the clock was "nighttime". Additionally, the night hours were split into 3 consecutive 4-h categories for further analysis. Stepwise, multivariate regressions were used to evaluate any effect of time of surgery on post-operative DFV or DFL. Other variables included in these statistical models were age, sex, mechanism of injury, open vs. closed fracture, trauma vs. non-trauma surgeon, and AO and Winquist classifications.


RESULTS
Overall, 22.4% (76/340) of all fractures were fixed at night. The mean post-operative DFV and DFL from the uninjured side in these patients was 8.9° and 4.1 mm, respectively, compared to 9.0° and 4.8 mm in those treated during the daytime. This difference was not statistically significant when accounting for other factors (p>0.05). There was no statistically significant difference in patients with >10 mm limb length discrepancy or >15 degrees DFV (p=1.0 for both).


CONCLUSIONS
The time of day at which diaphyseal femur fractures are treated does not have an impact on post-operative femoral version or length. While certain other injuries may be better handled during daytime hours, acceptable IMN of mid-shaft femur fractures may be achieved during all hours at a level 1 trauma centre.
NYU Hospital for Joint Diseases, Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, New York, NY, United States.
Neeraj M
NM
Patel
NYU Hospital for Joint Diseases, Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, New York, NY, United States.
Richard S
RS
Yoon
NYU Hospital for Joint Diseases, Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, New York, NY, United States.
John D
JD
Koerner
Hospital of the University of Pennsylvania, Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Philadelphia, PA, United States.
Derek J
DJ
Donegan
NYU Hospital for Joint Diseases, Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, New York, NY, United States. Electronic address: liporace33@gmail.com.
Frank A
FA
Liporace
D000328:Adult; D002983:Clinical Competence / Q000706:statistics & numerical data*; D005260:Female; D005264:Femoral Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005269:Femur / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary; D018460:Fractures, Comminuted / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007870:Leg Length Inequality / Q000000981:diagnostic imaging / Q000209:etiology; D008297:Male; D061646:Operative Time; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D016896:Treatment Outcome; D000078329:Workforce
Femoral length; Femoral shaft fracture; Femoral version; Intramedullary nail; Limb length discrepancy; Time of day