Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
, 76 (6), 1433-40

In-hospital Mortality From Femoral Shaft Fracture Depends on the Initial Delay to Fracture Fixation and Injury Severity Score: A Retrospective Cohort Study From the NTDB 2002-2006

Affiliations
Multicenter Study

In-hospital Mortality From Femoral Shaft Fracture Depends on the Initial Delay to Fracture Fixation and Injury Severity Score: A Retrospective Cohort Study From the NTDB 2002-2006

Robert Victor Cantu et al. J Trauma Acute Care Surg.

Abstract

Background: Optimal surgical timing for definitive treatment of femur fractures in severely injured patients remains controversial. This study was performed to examine in-hospital mortality for patients with femur fractures with regard to surgical timing, Injury Severity Score (ISS), and age.

Methods: The National Trauma Data Bank version 7.0 was used to evaluate in-hospital mortality for patients presenting with unilateral femur fractures. Patients were stratified into four groups by surgical timing (ST) and four groups by ISS. χ tests were used to evaluate baseline interrelationships. Binary regression was used to examine the association between time to surgery, ISS score, age, and mortality after adjusting for patient medical comorbidities, and personal demographics.

Results: A total of 7,540 patients met inclusion criteria, with a 1.4% overall in-hospital mortality rate. For patients with an isolated femur fracture, surgical delay beyond 48 hours was associated with nearly five times greater mortality risk compared with surgery within 12 hours (adjusted relative risk, 4.8; 95% confidence interval, 1.6-14.1). Only severely injured patients (ISS, 26+) had higher associated mortality with no delay in surgical fixation (ST1 < 12 hours) relative to ST2 of 13 hours to 24 hours with an adjusted relative risk of 4.2 (95% confidence interval, 1.0-16.7). The association between higher mortality rates and surgical delay beyond 48 hours was even stronger in the elderly patients.

Conclusion: This study supports the work of previous authors who reported that early definitive fixation of femur fractures is not only beneficial, particularly in the elderly, but also consistent with more recent studies recommending at least 12-hour to 24-hour delay in fixation in severely injured patients to promote better resuscitation.

Level of evidence: Therapeutic study, level III.

Conflict of interest statement

DISCLOSURE

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Figure 2
Figure 2
Adjusted in-hospital mortality rates by timing of operative fixation for patients with isolated femur fractures (ISS=9), mild to moderate injuries to other systems (ISS 10-15), moderate to severe injuries to other systems(ISS 16-25) and severe multi-system injuries (ISS 26+).
Figure 3
Figure 3
Adjusted in-hospital mortality rates by timing of operative fixation for patients under and over 65 years of age.

Similar articles

See all similar articles

Cited by 3 PubMed Central articles

Publication types

Feedback