title: Are bilateral tibial shaft fractures associated with an increased risk  for adverse outcome?
abstract: BACKGROUND
  Long bone fractures are assumed to be an independent risk factor for systemic complications and death after trauma. Multiple studies have identified an increased risk for mortality and morbidity in patients with bilateral femoral fractures. Data about bilateral tibial shaft fractures is rare. The aim of our study was to analyze if patients with bilateral tibial shaft fractures are at higher risk for systemic complications.
  
  
  METHODS
  We performed a retrospective analysis of the TraumaRegister DGU® from 1993 to 2008. Inclusion criteria were unilateral or bilateral tibial shaft fractures and an age ≥16. Additionally to the overall collective we analyzed different subgroups (divided into different injury severities and treatment periods).
  
  
  RESULTS
  1899 patients with unilateral and 175 patients with bilateral tibial shaft fractures were included. Age, gender and mean ISS (25.8 vs. 26.2, p = 0.51) in the two groups were comparable. Regarding the entire study population, patients with bilateral tibial shaft fractures showed no significant higher incidence of respiratory organ failure (29.5% vs. 23.1%, p = 0.076) or mortality (20.0% vs. 16.3%, p = 0.203). However, subgroup analysis showed a significant higher rate of pulmonary organ failure for bilateral tibial shaft fractures as compared to unilateral tibial shaft fractures in the group ISS < 25 (20.7% vs. 11.7%, p = 0.023). Multivariate regression analysis identified the additional tibial shaft fracture as an independent risk factor for pulmonary organ failure (OR = 1.56) but not for mortality.
  
  
  CONCLUSIONS
  The additional tibial shaft fracture is an independent risk factor for pulmonary organ failure but not for multiple organ failure or mortality. The impact of the additional tibial shaft fracture is especially pronounced in less severely injured patients (ISS < 25). These findings are comparable to results of bilateral femoral fracture studies and we therefore suggest to treat patients with bilateral tibial shaft fractures with the same caution as those with bilateral femoral fractures.
authors.forename: Philipp
authors.initials: P
authors.lastname: Lichte
authors.forename: Christian
authors.initials: C
authors.lastname: Weber
authors.forename: Richard M
authors.initials: RM
authors.lastname: Sellei
authors.forename: Frank
authors.initials: F
authors.lastname: Hildebrand
authors.forename: Rolf
authors.initials: R
authors.lastname: Lefering
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Pape
authors.forename: Philipp
authors.initials: P
authors.lastname: Kobbe
mesh_terms: D000328:Adult; D002648:Child; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000379:methods* / Q000401:mortality; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology; D009104:Multiple Trauma / Q000150:complications / Q000401:mortality* / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D012771:Shock, Hemorrhagic / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology; D013898:Thoracic Injuries / Q000150:complications / Q000401:mortality* / Q000503:physiopathology; D013978:Tibial Fractures / Q000401:mortality* / Q000503:physiopathology / Q000601:surgery; D014193:Trauma Centers; D016896:Treatment Outcome; D055815:Young Adult