Long bone fractures predispose to pulmonary dysfunction in blunt chest trauma despite early operative fixation

Recent reports have demonstrated a decreased incidence of pulmonary complications in patients who have undergone trauma after early operative fixation of long bone fractures. Few studies, however, have specifically examined the effect of associated long bone fractures and their management on pulmonary dysfunction in multiply injured patients with significant blunt chest trauma. We retrospectively reviewed 130 consecutive patients with major blunt chest injury as a component of multisystem trauma. Patients were assessed for overall injury severity and degree of pulmonary dysfunction after being categorized according to associated injury pattern (presence or absence of long bone fracture[s]) and treatment received (early operative fixation at less than 48 hours versus late fixation or nonoperative management). Patients with long bone fractures and concurrent blunt chest trauma had a higher incidence of pulmonary morbidity and death (p less than 0.05) than had patients with similar Injury Severity Scores without long bone fractures. Early operative fixation did not protect against pulmonary dysfunction or death in this group of patients. Despite early operative fixation, long bone fractures predispose patients with concurrent major blunt chest injury to increased pulmonary dysfunction.