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Single-Stage Versus 2-Stage Bilateral Intramedullary Nail Fixation in Patients With Bilateral Femur Fractures: A
Ilexa R Flagstad1,2, Lauren M Tatman1,3, Austin Heare1,2,4
1Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, MN.
Journal of Orthopaedic Trauma
|January 29, 2021
Summary
Single-stage intramedullary nailing for bilateral femur fractures may reduce acute respiratory distress syndrome (ARDS) rates. This largest multicenter study suggests potential benefits for polytrauma patients undergoing simultaneous fixation.
Area of Science:
- Orthopedic surgery
- Trauma care
- Biomedical engineering
Background:
- Bilateral femur fractures present complex management challenges.
- Intramedullary nailing (IMN) is a standard treatment for femur fractures.
- Comparing single-stage versus two-stage IMN for bilateral fractures is crucial for optimizing patient outcomes.
Purpose of the Study:
- To evaluate complication rates in patients with bilateral femur fractures treated with single-stage versus two-stage IMN.
- To compare the incidence of acute respiratory distress syndrome (ARDS) and in-hospital mortality between the two treatment approaches.
Main Methods:
- Multicenter retrospective review of 246 patients with bilateral femur fractures treated with IMN.
- Data collected from 10 Level-1 trauma centers between 1998 and 2018.
- Comparison of outcomes between 188 single-stage and 58 two-stage IMN procedures.
Main Results:
- The two-stage group had higher rates of ARDS (13.8% vs. 5.9%).
- Single-stage IMN was associated with a 78% reduced risk for ARDS after adjustment for multiple factors.
- In-hospital mortality was higher in the single-stage group (2.7% vs. 0%), but not statistically significant.
Conclusions:
- Single-stage bilateral femur IMN may decrease ARDS rates in polytrauma patients.
- Further prospective studies are needed to confirm effects on mortality and identify at-risk individuals.
- Simultaneous definitive fixation in a single stage may be beneficial for select patients.
