title: Early and late intramedullary nailing of femur fracture: A single center experience.
abstract: BACKGROUND
  Femur fracture (FF) is a common injury, and intramedullary nailing (IMN) is the standard surgical fixation. However, the time of intervention remains controversial. We aimed to describe the reamed IMN (rIMN) timing and hospital outcomes in trauma patients presenting with FF.
  
  
  METHODS
  A retrospective analysis was conducted for all patients admitted with FF and they underwent fixation at level 1 trauma unit between January 2010 and January 2012. Patients were divided into Group I with early rIMN (<12 h) and Group II with late rIMN (≥12 h). Patients' demographics, clinical presentations, mechanism of injury, pulmonary complications, organ failure, length of stay, and mortality were described.
  
  
  RESULTS
  A total of 307 eligible patients with FF were identified (156 patients in Group I and 151 patients in Group II). Patients in Group II were older (36 ± 18 vs. 29 ± 9;P= 0.001) and had higher rate of polytrauma (35% vs. 18%,P= 0.001), head injury (5% vs. 12%,P= 0.68) and bilateral FF (10.7% vs. 5.1%;P= 0.07) in comparison to Group I. Group II had longer stay in Intensive Care Unit (7 [1-56] vs. 2 [1-17] days;P= 0.009) and hospital (13 [2-236] vs. 9 [1-367];P= 0.001). There were no significant differences in outcomes between the two groups in terms of sepsis, renal failure, fat embolism, adult respiratory distress syndrome and death.
  
  
  CONCLUSIONS
  Based on this analysis, we believe that early rIMN is safe in appropriately selected cases. In patients with traumatic FFs, early rIMN is associated with low hospital complications and shorter hospital stay. The rate of pulmonary complications is almost the same in the early and late group. Further prospective randomized studies with large sample size would be ideal using the information garnered from the present study.
authors.affiliation: Department of Orthopedic Surgery, Al-Wakra Hospital, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Ahmad S
authors.initials: AS
authors.lastname: Alobaidi
authors.affiliation: Department of Surgery, Section of Trauma Surgery, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Ammar
authors.initials: A
authors.lastname: Al-Hassani
authors.affiliation: Department of Surgery, Section of Trauma Surgery, Clinical Research, Hamad Medical Corporation, Doha, Qatar; Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar.
authors.forename: Ayman
authors.initials: A
authors.lastname: El-Menyar
authors.affiliation: Department of Surgery, Section of Trauma Surgery, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Husham
authors.initials: H
authors.lastname: Abdelrahman
authors.affiliation: Department of Surgery, Section of Trauma Surgery, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Mazin
authors.initials: M
authors.lastname: Tuma
authors.affiliation: Department of Surgery, Section of Trauma Surgery, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Hassan
authors.initials: H
authors.lastname: Al-Thani
authors.affiliation: Department of Orthopedic Surgery, Al-Wakra Hospital, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Mohammed A
authors.initials: MA
authors.lastname: Aldosari
keywords: Femur; fracture; intramedullary nailing; outcomes; reamed; timing; trauma