title: Clinical outcomes following invasive versus noninvasive preoperative stabilization of closed diaphyseal femur fractures.
abstract: BACKGROUND
  The use of invasive traction (INV-T) to stabilize femur fractures prior to fixation (open reduction and internal fixation, ORIF) remains controversial. Some centers have utilized noninvasive traction (NINV-T) or splinting preoperatively. It is possible that INV-T decreases hemorrhage. However, the use of INV-T in pediatric patients and for femoral neck fractures in adults is associated with worsened outcomes. We hypothesized that there is no difference in the need for transfusion between those who receive INV-T and NINV-T.
  
  
  METHODS
  A retrospective study was performed at two level I and one level II trauma center from January 2006 to December 2009. Patients ≥18 years with a closed diaphyseal femur fracture who underwent ORIF within 48 h of arrival were included. Patients were grouped by method of preoperative fracture stabilization. Primary endpoint was need for transfusion. A power analysis found that 94 patients were needed to detect a 25 % difference with 80 % power.
  
  
  RESULTS
  Fifty-six (22 %) received INV-T and 199 (78 %) received NINV-T stabilization. No significant differences were found between groups in terms of age, injury severity score, or ORIF method. There was no significant difference between the two groups in the hemoglobin value on arrival, preoperative hemoglobin value, or the difference between admission and preoperative hemoglobin values. We did not find a significant difference in the need for red blood cell transfusion between the two groups. There was no difference in length of stay or discharge destination.
  
  
  CONCLUSIONS
  INV-T is not associated with improved outcomes in adult patients with closed mid-shaft femoral fractures who are operated upon within 48 h of arrival.
authors.affiliation: Division of Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania, Philadelphia, USA.
authors.forename: D
authors.initials: D
authors.lastname: Holena
authors.affiliation: Department of Surgery, Madigan Army Medical Center, Tacoma, USA.
authors.forename: D
authors.initials: D
authors.lastname: Stoddard
authors.affiliation: Division of Acute Care Surgery, Thomas Jefferson University, Philadelphia, USA.
authors.forename: N D
authors.initials: ND
authors.lastname: Martin
authors.affiliation: Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, USA.
authors.forename: B
authors.initials: B
authors.lastname: Winters
authors.affiliation: Department of Orthopedic Surgery, The Reading Hospital and Medical Center, West Reading, USA.
authors.forename: J
authors.initials: J
authors.lastname: Casey
authors.affiliation: Division of Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania, Philadelphia, USA.
authors.forename: J
authors.initials: J
authors.lastname: Pascual
authors.affiliation: Division of Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania, Philadelphia, USA.
authors.forename: C
authors.initials: C
authors.lastname: Sims
authors.affiliation: Division of Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania, Philadelphia, USA. bsarani@mfa.gwu.edu.|, 2150 Pennsylvania Ave, NW, Suite 6B, Washington, DC, 20037, USA. bsarani@mfa.gwu.edu.
authors.forename: B
authors.initials: B
authors.lastname: Sarani
keywords: Femur fracture; Traction
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