Factors influencing management of bilateral femur fractures: A multicenter retrospective cohort of early versus delayed definitive Fixation

Flagstad, Ilexa; MacCormick, Lauren M.; Albersheim, Melissa; Heare, Austin; Parikh, Harsh R.; Vang, Sandy; Westberg, Jerald R.; Chaffin, Danielle Ries de; Schmidt, Tegan; Breslin, Mary A.; Simske, Natasha M.; Siy, Alexander B.; Lufrano, Reuben; Rodriguez-Buitrago, Andres; Labrum, Joseph T.; Shaw, Nichole; Only, Arthur J.; Nadeau, Jason; Davis, Patrick; Steverson, Barbara; Lund, Erik A.; Connelly, Daniel; Atchison, Jared; Mauffrey, Cyril; Hak, David J.; Titter, Julie; Feinstein, Shawn; Hahn, Jesse C.; Sagi, H. Claude; Whiting, Paul S.; Mir, Hassan R.; Schmidt, Andrew H.; Wagstrom, Emily; Obremskey, William T.; O’Toole, Robert V.; Vallier, Heather A.; Cunningham, Brian

doi:10.1016/j.injury.2021.02.091

Cited by 4 publications

(1 citation statement)

References 42 publications

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“…7,11,14 Fixation within 36 to 48 hours of injury has been associated with fewer complications and shorter lengths of stay in multiple recent reports. 5,7,11,13,14,22,[32][33][34][35][36] Assessment of coagulopathy. In most cases, any coagulopathy arising from haemorrhage due to injury will improve as transfusions are provided to address any prior or ongoing bleeding.…”

Section: Introductionmentioning

confidence: 99%

Continuous improvement in optimizing the timing of axial, hip, and femoral fracture fixation

Vallier

2023

Bone Joint J

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Benefits of early stabilization of femoral shaft fractures, in mitigation of pulmonary and other complications, have been recognized over the past decades. Investigation into the appropriate level of resuscitation, and other measures of readiness for definitive fixation, versus a damage control strategy have been ongoing. These principles are now being applied to fractures of the thoracolumbar spine, pelvis, and acetabulum. Systems of trauma care are evolving to encompass attention to expeditious and safe management of not only multiply injured patients with these major fractures, but also definitive care for hip and periprosthetic fractures, which pose a similar burden of patient recumbency until stabilized. Future directions regarding refinement of patient resuscitation, assessment, and treatment are anticipated, as is the potential for data sharing and registries in enhancing trauma system functionality.Cite this article: Bone Joint J 2023;105-B(4):361–364.

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Section: Introductionmentioning

confidence: 99%

Continuous improvement in optimizing the timing of axial, hip, and femoral fracture fixation

Vallier

2023

Bone Joint J

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Developments in the understanding of staging a “major fracture” in polytrauma: results from an initiative by the polytrauma section of ESTES

Kalbas

Klingebiel

Halvachizadeh

et al. 2023

Eur J Trauma Emerg Surg

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Purpose Although the term “major fracture” is commonly used in the management of trauma patients, it is defined insufficiently to date. The polytrauma section of ESTES is trying to develop a more standardized use and a definition of the term. In this process, a standardized literature search was undertaken. We test the hypothesis that the understanding of “major fractures” has changed and is modified by a better understanding of patient physiology. Methods A systematic literature search of the Medline and EMBASE databases was conducted in March 2022. Original studies that investigated surgical treatment strategies in polytraumatized patients with fractures were included: This included timing, sequence and type of operative treatment. A qualitative synthesis regarding the prevalence of anatomic regions of interest and core factors determining decision-making was performed. Data were stratified by decades. Results 4278 articles were identified. Of these, 74 were included for qualitative evaluation: 50 articles focused on one anatomic region, 24 investigated the relevance of multiple anatomic regions. Femur fractures were investigated most frequently (62) followed by pelvic (22), spinal (15) and tibial (15) fractures. Only femur (40), pelvic (5) and spinal (5) fractures were investigated in articles with one anatomic region of interest. Before 2010, most articles focused on long bone injuries. After 2010, fractures of pelvis and spine were cited more frequently. Additional determining factors for decision-making were covered in 67 studies. These included chest injuries (42), TBI (26), hemorrhagic shock (25) and other injury-specific factors (23). Articles before 2000 almost exclusively focused on chest injury and TBI, while shock and injury-specific factors (e.g., soft tissues, spinal cord injury, and abdominal trauma) became more relevant after 2000. Conclusion Over time, the way “major fractures” influenced surgical treatment strategies has changed notably. While femur fractures have long been the only focus, fixation of pelvic and spinal fractures have become more important over the last decade. In addition to the fracture location, associated conditions and injuries (chest trauma and head injuries) influence surgical decision-making as well. Hemodynamic stability and injury-specific factors (soft tissue injuries) have increased in importance over time.

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Two big bones, one big decision: When to fix bilateral femur fractures

Arnold,

Lagazzi,

Wagner

et al. 2024

Injury

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Factors influencing management of bilateral femur fractures: A multicenter retrospective cohort of early versus delayed definitive Fixation

Cited by 4 publications

References 42 publications

Continuous improvement in optimizing the timing of axial, hip, and femoral fracture fixation

Continuous improvement in optimizing the timing of axial, hip, and femoral fracture fixation

Developments in the understanding of staging a “major fracture” in polytrauma: results from an initiative by the polytrauma section of ESTES

Two big bones, one big decision: When to fix bilateral femur fractures

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