Risk of Mortality: The Relationship With Associated Injuries and Fracture Treatment Methods in Patients With Unilateral or Bilateral Femoral Shaft Fractures

Willett, Keith; Al-Khateeb, Hesham; Kotnis, Rohit; Bouamra, Omar; Lecky, Fiona

doi:10.1097/ta.0b013e3181e6138a

Cited by 41 publications

(37 citation statements)

References 22 publications

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“…It may be that patients who survive the early stresses of high-energy trauma have enough physiologic reserve to survive after hospital discharge. The association of mortality with ISS and age was seen in our study and has been confirmed in other studies [4,6,12,27]. The cumulative injuries, that is, the ISS and influence of physiologic reserve may play a greater role in mortality for this group of patients rather than the presence of a high-energy femur fracture.…”

Section: Discussionsupporting

confidence: 77%

“…Approximately 10% of patients in this group did not have orthopaedic surgery secondary to death in an emergency department or death during or after initial general surgery intervention, and one patient who was nonambulatory refused surgery. Low-energy femur fractures have been studied extensively in the elderly population [3,4,[22][23][24]27]. However, the impact of high-energy femur fractures in elderly patients with trauma has not been reported to our knowledge.…”

Section: Discussionmentioning

confidence: 94%

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High-energy Femur Fractures Increase Morbidity but not Mortality in Elderly Patients

Patel

Brennan

Davis

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Trauma centers are projected to have an increase in the number of elderly patients with high-energy femur fractures. Greater morbidity and mortality have been observed in these patients. Further clarification regarding the impact of high-energy femur fractures is necessary in this population. Questions/purposes Our purpose was to assess the influence of high-energy femur fractures on mortality and morbidity in patients 60 years and older. Specifically, we asked (1) if the presence of a high-energy femur fracture increases in-hospital, 6-month, and 1-year mortality in patients 60 years and older, and (2) if there is a difference in morbidity (number of complications, intensive care unit [ICU] and total hospital length of stay, discharge disposition, accompanying fractures, and surgical intervention) between patients 60 years and older with and without highenergy femur fractures.Methods A retrospective review of 242 patients was performed. Patients with traumatic brain injury or spine injury with a neurologic deficit were excluded. A control group, including patients admitted secondary to highenergy trauma without femur fractures, was matched by gender and Injury Severity Score (ISS). In-hospital mortality, 6-month and 1-year mortality, complications, ICU and total hospital length of stay, discharge disposition, accompanying fractures, surgical intervention, and covariates were recorded. Statistical analyses using Fisher's exact test, ANOVA, Kaplan-Meier estimates, and Cox regression models were performed to show differences in mortality (in-hospital, 6-month, 1-year), complications, length of ICU and total hospital stay, discharge disposition, surgical intervention, and accompanying fractures between elderly patients with and without femur fractures. The average ages of the patients were 72.8 years (± 9 years) in the femur fracture group and 71.8 years (± 9 years) in the control group. Sex, age, ISS, and comorbidities were homogenous between groups. Results In-hospital (p = 0.45), 6-month (p = 0.79), and 1-year mortality (p = 0.55) did not differ in patients with and without high-energy femur fractures. Elderly patients with high-energy femur fractures had an increased number of complications (p = 0.029), longer total hospital length of stay (p = 0.039), were discharged more commonly to rehabilitation centers (p \ 0.005), had more accompanying long bone fractures (p = 0.002), and were more likely to have surgery (p \ 0.001). Average ICU length of stay was similar between the two groups (p = 0.17). Conclusions High-energy femur fractures increased morbidity in patients 60 years and older; however, no increase in mortality was observed in our patients. Concomitant injuries may play a more critical role in this population. Additional studies are necessary to clarify the Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose ...

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 94%

High-energy Femur Fractures Increase Morbidity but not Mortality in Elderly Patients

Patel

Brennan

Davis

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…Сочетание перелома бедренной кости, в особеннос-ти билатерального, с множественными переломами ребер и повреждениями внутренних органов груди с гемо-и пневмотораксом существенно увеличивает кровопотерю и шокогенность политравмы, повышает вероятность раннего смертельного исхода [7][8][9].…”

Section: патофизиология взаимного отягощения скелетных и торакальных unclassified

“…Однако при сравнении летальности в группах боль-ных, сопоставимых по тяжести политравмы по шкале ISS, не выявлено преимущества тактики DCO перед ETC в лечении билатеральных переломов бедренной кости [60]. Но все же при тяжести политравмы по шкале NISS более 40 баллов следование тактике DCO в лечении билатеральных переломов бедренной кости сопровождалось наименьшей летальностью [9].…”

Section: стратегия «безопасного окончательного остеосинтеза» при полиunclassified

Advantages and Dangers of Early Osteosynthesis of Femur in Polytrauma With Chest Injur

Шапкин¹,

Seliverstov²

2017

Neotložnaâ med. pomoŝʹ

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ФГБОУ ВО «Саратовский государственный медицинский университет имени В.И. Разумовского» Министерства здраво-охранения Российской Федерации, Саратов, Российская Федерация * Контактная информация: Селиверстов Павел Андреевич, кандидат медицинских наук, ассистент кафедры общей хирургии ФГБОУ ВО Саратовский ГМУ им. В.И. Разумовского Минздрава России. E-mail: seliwerstov.pl@yandex.ru РЕЗЮМЕ В обзоре представлены результаты экспериментальных и клинических исследований влияния раннего остеосинтеза при переломе бедренной кости на развитие системных осложнений и ис-хода политравмы с повреждениями груди. Рассмотрена роль сочетания торакальных поврежде-ний с переломом бедренной кости, а также ее интрамедуллярного остеосинтеза в механизмах формирования местной и системной воспалительной реакции, коагулопатии, жировой и тромбо-эмболии в легких, дыхательной недостаточности. Изложены концепции «немедленной тотальной помощи», «контроля ортопедических повреждений» применительно к переломам бедренной кости, сочетанных с травмой груди. Приведены критерии относительной безопасности выпол-нения окончательного остеосинтеза бедренной кости при политравме с торакальными повреж-дениями. Ключевые слова:политравма, перелом бедренной кости, повреждения груди, легочные осложнения, «второй удар», воспалительный ответ, коагулопатия, контроль скелетных повреждений, интрамедулляр-ный остеосинтез Ссылка для цитирования Конфликт интересовАвторы заявляют об отсутствии конфликтов интересов БлагодарностиИсследование не имеет спонсорской поддержки ДНК -дезоксирибонуклеиновая кислота ИВЛ -искусственная вентиляция легких ОРДС -острый респираторный дистресс-синдром ПОН -полиорганная недостаточность СВР -системная воспалительная реакция ТЭЛА -тромбоэмболия легочной артерии

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“…In particular, bilateral femur fractures result from high-velocity impacts, leading to complex fractures and severe injuries of the surrounding soft tissue envelope [35]. These injuries are characterized by high blood loss [6], severe generalized autodestructive inflammation [16], and remote organ damage [6,16,28].…”

Section: Introductionmentioning

confidence: 99%

Cumulative Effects of Bone and Soft Tissue Injury on Systemic Inflammation: A Pilot Study

Pfeifer

Darwiche

Kohut

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background In multiply injured patients, bilateral femur fractures invoke a substantial systemic inflammatory impact and remote organ dysfunction. However, it is unclear whether isolated bone or soft tissue injury contributes to the systemic inflammatory response and organ injury after fracture. Questions/purposes We therefore asked whether the systemic inflammatory response and remote organ dysfunction are attributable to the bone fragment injection, adjacent soft tissue injury, or both. Methods Male C57/BL6 mice (8-10 weeks old, 20-30 g) were assigned to four groups: bone fragment injection (BF, n = 9) group; soft tissue injury (STI, n = 9) group; BF + STI (n = 9) group, in which both insults were applied; and control group, in which neither insult was applied. Animals were sacrificed at 6 hours. As surrogates for systemic inflammation, we measured serum IL-6, IL-10, osteopontin, and alanine aminotransferase (ALT) and nuclear factor (NF)-jB and myeloperoxidase (MPO) in the lung. Results The systemic inflammatory response (mean IL-6 level) was similar in the BF (61.8 pg/mL) and STI (67.9 pg/mL) groups. The combination (BF + STI) of both traumatic insults induced an increase in mean levels of inflammatory parameters

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Risk of Mortality: The Relationship With Associated Injuries and Fracture Treatment Methods in Patients With Unilateral or Bilateral Femoral Shaft Fractures

Cited by 41 publications

References 22 publications

High-energy Femur Fractures Increase Morbidity but not Mortality in Elderly Patients

High-energy Femur Fractures Increase Morbidity but not Mortality in Elderly Patients

Advantages and Dangers of Early Osteosynthesis of Femur in Polytrauma With Chest Injur

Cumulative Effects of Bone and Soft Tissue Injury on Systemic Inflammation: A Pilot Study

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