title: Do stable multiply injured patients with bilateral femur fractures have higher complication rates? An investigation by the EPOFF study group.
abstract: BACKGROUND
  Polytrauma patients with bilateral femur shaft fractures are known to have a higher rate of complications when compared with those who have sustained unilateral fractures. The current study tests the hypothesis that the high incidence of posttraumatic complications in patients who do not have a severe head or chest injury is caused by accompanying injuries rather than by the additional femur fracture.
  
  
  METHODS
  Inclusion criteria New Injury Severity Score > 16 points; AIS score value of the chest ≤3 points and no severe head injury. Two study groups: a unilateral group (USF group) (n = 146) and a bilateral femur shaft fracture group (BSF group) (n = 19). Endpoints monitored were length of stay in the intensive care unit, duration on a ventilator, and several postsurgical complications (e.g., SEPSIS, acute lung injury). Statistics Fisher's exact test for binary variables, and independent t-tests and regression analyses for continuous indicators of injury severity and clinical outcomes.
  
  
  RESULTS
  Patients with bilateral femur fractures had a significantly higher incidence of hemothorax. Moreover, they received blood transfusions more often upon admission, and exhibited a longer ICU stay (p = 0.008). However, this patient group did not exhibit a significantly higher incidence of postsurgical complications (p = 0.1) than those with unilateral fractures. After adjusting for injury severity, no difference in the length of the ICU stay was observed. Bilateral fracture patients who were in an uncertain condition preoperatively had a longer length of stay in the ICU postoperatively (p = 0.002).
  
  
  CONCLUSIONS
  In the absence of major head or chest injuries, patients with multiple injuries and bilateral femur shaft fractures have a similar complication rate to polytrauma patients with unilateral fractures. Moreover, an uncertain condition preoperatively was associated with an increased stay in the intensive care unit. The results support the idea that associated injuries rather than the additional femur fracture are responsible for complications during the clinical stay.
authors.affiliation: Department of Orthopaedic Surgery, University of Aachen Medical Center, 30 Pauwels Street, 52074, Aachen, Germany. rpfeifer@ukaachen.de.|Department of Trauma Surgery, University of Aachen Medical Center, Aachen, Germany. rpfeifer@ukaachen.de.
authors.forename: Roman
authors.initials: R
authors.lastname: Pfeifer
authors.affiliation: Department of Orthopaedics and Trauma Surgery, University of Witten Herdecke and Cologne, Witten, Germany.
authors.forename: Dieter
authors.initials: D
authors.lastname: Rixen
authors.affiliation: Orthopaedic Centre, Ullevaal University Hospital, Oslo, Norway.
authors.forename: Elisabeth Ellingsen
authors.initials: EE
authors.lastname: Husebye
authors.affiliation: Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Dustin
authors.initials: D
authors.lastname: Pardini
authors.affiliation: Department Trauma Surgery, Plastic and Reconstructive Surgery, University of Göttingen, Göttingen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Müller
authors.affiliation: Department Trauma Surgery, Plastic and Reconstructive Surgery, University of Göttingen, Göttingen, Germany.
authors.forename: Clemens
authors.initials: C
authors.lastname: Dumont
authors.affiliation: Department of Trauma, Celle General Hospital, Celle, Germany.
authors.forename: Hans Georg
authors.initials: HG
authors.lastname: Oestern
authors.affiliation: Department of Trauma and Orthopaedics, University of Leeds, Leeds, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Giannoudis
authors.affiliation: Department of Orthopaedic Surgery, University of Aachen Medical Center, 30 Pauwels Street, 52074, Aachen, Germany. papehc@aol.com.
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Pape
keywords: Complications; Femur fracture; Polytrauma; Risk factors
references.citation: J Orthop Trauma. 2000 Nov;14(8):534-41
references.pmid: 11149498
references.citation: J Trauma. 1997 May;42(5):895-903; discussion 903-4
references.pmid: 9191672
references.citation: Clin Orthop Relat Res. 2004 May;(422):37-42
references.pmid: 15187831
references.citation: J Trauma. 1992 Mar;32(3):289-93
references.pmid: 1548715
references.citation: Ann Surg. 2007 Sep;246(3):491-9; discussion 499-501
references.pmid: 17717453
references.citation: J Trauma. 1989 May;29(5):623-9
references.pmid: 2657085
references.citation: Arch Surg. 1983 Oct;118(10):1190-2
references.pmid: 6615203
references.citation: Eur J Anaesthesiol. 2007 Apr;24(4):355-61
references.pmid: 17087849
references.citation: Shock. 1996 Mar;5(3):202-7
references.pmid: 8696984
references.citation: Clin Orthop Relat Res. 1995 Nov;(320):115-8
references.pmid: 7586813
references.citation: Clin Orthop Relat Res. 2003 Oct;(415):272-8
references.pmid: 14612656
references.citation: J Trauma. 1974 Sep;14(9):783-90
references.pmid: 4412559
references.citation: J Trauma. 1998 Apr;44(4):580-2
references.pmid: 9555825
references.citation: J Trauma. 1991 Jan;31(1):1-7
references.pmid: 1986111
references.citation: J Trauma. 1980 May;20(5):399-402
references.pmid: 7365853
references.citation: Radiol Clin North Am. 1973 Dec;11(3):527-41
references.pmid: 4586459
references.citation: Surgery. 1970 Mar;67(3):499-506
references.pmid: 4905118
references.citation: J Trauma. 1974 Mar;14(3):187-96
references.pmid: 4814394
references.citation: J Bone Joint Surg Am. 1989 Mar;71(3):336-40
references.pmid: 2925704
references.citation: J Trauma. 1991 May;31(5):629-36; discussion 636-8
references.pmid: 2030509
references.citation: Surg Clin North Am. 1977 Feb;57(1):17-36
references.pmid: 854851
references.citation: Int Orthop. 2000;24(5):264-7
references.pmid: 11153455
references.citation: J Trauma. 1984 Aug;24(8):742-6
references.pmid: 6471139
references.citation: J Orthop Trauma. 2005 Sep;19(8):551-62
references.pmid: 16118563