In-Hospital Morbidity and Mortality With Delays in Femoral Shaft Fracture Fixation

Area of Science:

• Trauma surgery
• Orthopedic surgery
• Health services research

Background:

• Femoral shaft fractures are common injuries in trauma patients.
• The timing of surgical fixation for these fractures may impact patient outcomes.
• Understanding trends and predictors of delayed fixation is crucial for improving care.

Purpose of the Study:

• To examine trends in the timing of femur fracture fixation in US trauma centers.
• To identify factors associated with delayed treatment.
• To analyze the impact of fixation timing on in-hospital morbidity and mortality.

Main Methods:

• Retrospective analysis of 108,825 unilateral femoral shaft fractures from the National Trauma Data Bank (2007-2015).
• Patients grouped by fixation timing: <24 hours, 24-48 hours, and >48 hours.
• Primary outcome: in-hospital postoperative mortality. Secondary outcomes: complication rates, hospital and ICU length of stay, ventilator days.

Main Results:

• 74.2% of fractures were fixed within 24 hours.
• Fixation delayed >48 hours was associated with significantly higher mortality (OR 3.60), longer hospital LOS (OR 2.14), longer ICU LOS (OR 3.92), more ventilator days (OR 5.38), and more complications (OR 2.05).
• Overall mortality rate was 1.6%.

Conclusions:

• Delayed fixation of femoral shaft fractures is linked to increased patient morbidity and mortality.
• Patients with fixation >48 hours face the highest risks.
• Expedited operative fixation is recommended, balancing patient optimization needs.