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Femur fractures in chest-injured patients: is reaming contraindicated?
D W Carlson1, G H Rodman, D Kaehr
1Phoenix Orthopaedic Residency Program, Maricopa County Medical Center, Arizona 85006, USA.
Insights
Reamed femoral intramedullary nailing did not increase pulmonary complications in chest-injured patients. Nonreamed fixation, however, was associated with higher rates of adult respiratory distress syndrome (ARDS) and more ventilator days.
Area of Science:
- Trauma Surgery
- Orthopedic Surgery
- Critical Care Medicine
Background:
- Chest injuries are associated with significant pulmonary complications.
- Femoral fractures are common in trauma patients.
- The management of femoral fractures in patients with concomitant chest injuries requires careful consideration to minimize pulmonary morbidity.
Purpose of the Study:
- To investigate whether reamed femoral intramedullary nailing influences pulmonary complications in patients with chest injuries.
- To compare pulmonary outcomes between different methods of femoral fixation in chest-injured patients.
Main Methods:
- Retrospective review of a prospectively collected trauma database from 1991 to 1994 at a Level I Trauma Center.
- Patients were categorized into four groups based on chest injury severity and femoral fixation method.
- Pulmonary outcomes including adult respiratory distress syndrome (ARDS) and ventilator days were analyzed.
Main Results:
- Reamed femoral intramedullary nailing (Group II) showed similar pulmonary complication rates to chest-injured patients without femur fractures (Group I).
- Nonreamed femoral fixation (Group III) was associated with significantly higher ARDS incidence and ventilator days compared to Groups I and II.
- After adjusting for injury severity, no significant differences in pulmonary outcomes were observed between reamed nailing and other fixation methods in chest-injured patients.
Conclusions:
- Reamed intramedullary femoral fixation does not increase pulmonary morbidity in patients with chest injuries.
- Nonreamed fixation methods may be associated with increased pulmonary complications in this patient population.
- Optimal management of femoral fractures in chest-injured patients should consider fixation techniques to mitigate pulmonary risks.
Objective:
To determine if reamed femoral intramedullary nailing increases the pulmonary complications seen in chest-injured patients.
Design:
Retrospective review of prospectively collected trauma database data from January 1991 to October 1994.
Setting:
Methodist Hospital, Indianapolis, Indiana, Level I Trauma Center.
Patients:
Group I: Chest-injured patients [chest Abbreviated Injury Score (AIS) > or = 2] without femur or tibia fractures. Group II: Chest-injured patients (chest AIS > or = 2) with femoral reamed intramedullary fixation. Group III: Chest-injured patients (chest AIS > or = 2) with femoral shaft fixation using nonreamed fixation (rush rods, plating, or external fixation). Group IV: Non-chest-injured patients (chest AIS < 2) with femoral reamed intramedullary fixation. MAIN OUTCOME MEASUREMENT/HYPOTHESIS: Reamed femoral intramedullary nailing does not alter pulmonary outcomes, even in chest-injured patients.
Results:
Groups I and II had a very similar incidence of adult respiratory distress syndrome (ARDS), pneumonia, and number of ventilator days. Group III had a significantly higher incidence of ARDS and number of ventilator days than did Group I or II. Group III did not have a chest AIS score significantly different than Groups I and II. Group II had significantly higher ARDS and more ventilator days than did Group IV when only analyzing raw data. When injury severity was adjusted, there were no significant differences in pulmonary outcomes.
Conclusion:
Reamed intramedullary femoral fixation did not increase pulmonary morbidity in chest-injured patients.