Femoral canal reaming in the polytrauma patient with chest injury. A clinical perspective

It has been well documented that early fracture stabilization reduces morbidity and mortality in the patient who is multiply injured. However, controversy has developed recently concerning the timing and type of stabilization for the patient with multiple injuries who has sustained a femoral fracture and an associated severe chest injury. Reports from Europe have indicated an increased mortality rate and adult respiratory distress syndrome rate in the patient treated with reamed femoral rodding. A retrospective review of patients with multiple injuries with Injury Severity Scores of 18 points or greater who also had severe chest trauma was done at the Erie County Medical Center, Buffalo, NY. Three groups of patients were developed and studied: The patients in Group 1 had femoral fractures that were treated with early stabilization with a reamed rod; the patients in Group 2 had femoral fractures stabilized with plate fixation; and in Group 3, there were no femoral fractures. The Injury Severity Score for each group was nearly the same; however, the intensive care unit time was more than doubled in Group 2 and Group 3. There was a 33% adult respiratory distress syndrome rate in Group 2, a 27% rate in Group 3, and a 0% rate in Group 1. The mortality rate was highest for the group of patients without femoral fractures (Group 3), 10.9%. These clinical data seem to associate the chest injury with the increased adult respiratory distress syndrome and mortality rate, not the method of treatment for the femoral fracture.