Delayed Internal Fixation of Femoral Shaft Fracture Reduces Mortality Among Patients with Multisystem Trauma

Is Reconstruction Nailing of All Femoral Shaft Fractures Cost Effective? A Decision Analysis

“…As a base model from literature review, we assumed that 5% of shaft fractures had an ipsilateral femoral neck fracture, and 37% were missed and required further surgery and its associated costs and complications. [1][2][3][4][5][6]9,13,14,[18][19][20][21] The rates of ipsilateral neck and shaft fractures and of missed femoral neck fractures and the probabilities of complications of missed and treated femoral neck fractures were obtained from the literature and were averaged using a weighted average. 3,4,8 The rates of avascular necrosis and nonunion were combined as complications, and this weighted average was used as the base rate in the model.…”

“…These 2 cost effectiveness can be analyzed and the difference between them is the ICER (difference in costs by the difference in effectiveness). Probability of femoral neck fracture complications 0.200 0.00 0.50 1-6, 9, 12, 13, 16-20 Probability of reconstruction nail complications 0.010 0.00 0.02 16,22 Probability of death from femur fracture 0.035 0.00 0.10 21 Probability of missed femoral neck fracture 0.370 0.00 0.60 1-6, 9, 12, 13, 16-20 Probability of ipsilateral hip fracture 0.068 0.00 0.20 1-6, 9, 12, 13, 16-20 Utilities Reconstruction nail 0.969 0.800 1.000 16,27 Reconstruction nail complications 0.820 0.500 1.000 12,16,27 Complications such as a revision of an endoprosthesis. The authors assumed that the morbidity associated with the above major complications would be a disutility of 0.3 or 24 weeks at 0.5 QALY.…”

Large-magnitude Pelvic and Retroperitoneal Tissue Damage Predicts Organ Failure

“…Multiple studies have shown that MIPs with axial orthopaedic injuries are at risk of developing systemic complications [2,15,18,19,28]. Timing and choices of interventions in these patients remain controversial and are largely anecdotal [10-12, 16, 20, 21, 27].…”

L’inchiodamento femorale anterogrado nelle fratture diafisarie femorali

“…È quindi nostro parere che effettuare al più presto la sintesi in questa tipologia di pazienti sia la condotta migliore. Nei pazienti con politrauma (ISS >15) gli studi retrospettivi di Morshed [4] e altri indicano che una sintesi differita di 12 o più ore migliora del 50% la sopravvivenza in pazienti con lesioni addominali associate a una frattura femorale e che il tasso di complicanze sistemiche si riduce se viene attuato un protocollo di "damage control" con fissazione esterna temporanea delle fratture. Nella nostra esperienza la conversione diretta della fissazione esterna, effettuata entro 7-10 giorni, anche in altri segmenti ossei, non ha determinato alcuna infezione.…”