Impact of the method of initial stabilization for femoral shaft fractures in patients with multiple injuries at risk for complications (borderline patients)

Hans Christoph Pape, Dieter Rixen, John Morley, Elisabeth Ellingsen Husebye, Michael Mueller, Clemens Dumont, Andreas Gruner, Hans Joerg Oestern, Michael Bayeff-Filoff, Christina Garving, Dustin Pardini, Martijn Van Griensven, Christian Krettek, Peter Giannoudis, A. Gruner, M. Wittke, C. Dumont, K. Grimme, M. Mueller, D. RixenJ. Morley, R. Stiletto, E. Ellingsen Husbye, R. Bayeff-Filoff

Research output: Contribution to journalArticle

151 Citations (Scopus)

Abstract

OBJECTIVES: The timing of definitive fixation for major fractures in patients with multiple injuries is controversial. To address this gap, we randomized patients with blunt multiple injuries to either initial definitive stabilization of the femur shaft with an intramedullary nail or an external fixateur with later conversion to an intermedullary nail and documented the postoperative clinical condition. METHODS: Multiply injured patients with femoral shaft fractures were randomized to either initial (16 points, or 3 fractures and Abbreviated Injury Scale score ≥2 points and another injury (Abbreviated Injury Scale score ≥2 points), and age 18 to 65 years. Exclusion: patients in unstable or critical condition. Patients were graded as stable or borderline (increased risk of systemic complications). OUTCOMES: Incidence of acute lung injuries. RESULTS: Ten European Centers, 165 patients, mean age 32.7 ± 11.7 years. Group intramedullary nailing, n = 94; group external fixation, n = 71. Preoperatively, 121 patients were stable and 44 patients were in borderline condition. After adjusting for differences in initial injury severity between the 2 treatment groups, the odds of developing acute lung injury were 6.69 times greater in borderline patients who underwent intramedullary nailing in comparison with those who underwent external fixation, P <0.05. CONCLUSION: Intramedullary stabilization of the femur fracture can affect the outcome in patients with multiple injuries. In stable patients, primary femoral nailing is associated with shorter ventilation time. In borderline patients, it is associated with a higher incidence of lung dysfunctions when compared with those who underwent external fixation and later conversion to intermedullary nail. Therefore, the preoperative condition should be when deciding on the type of initial fixation to perform in patients with multiple blunt injuries.

Original languageEnglish (US)
Pages (from-to)491-499
Number of pages9
JournalAnnals of Surgery
Volume246
Issue number3
DOIs
StatePublished - Sep 2007
Externally publishedYes

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Femoral Fractures
Multiple Trauma
Nails
Abbreviated Injury Scale
Intramedullary Fracture Fixation
Nonpenetrating Wounds
Acute Lung Injury
Femur
Fracture Fixation
Incidence
Wounds and Injuries
Thigh
Ventilation

ASJC Scopus subject areas

  • Surgery

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Impact of the method of initial stabilization for femoral shaft fractures in patients with multiple injuries at risk for complications (borderline patients). / Pape, Hans Christoph; Rixen, Dieter; Morley, John; Husebye, Elisabeth Ellingsen; Mueller, Michael; Dumont, Clemens; Gruner, Andreas; Oestern, Hans Joerg; Bayeff-Filoff, Michael; Garving, Christina; Pardini, Dustin; Van Griensven, Martijn; Krettek, Christian; Giannoudis, Peter; Gruner, A.; Wittke, M.; Dumont, C.; Grimme, K.; Mueller, M.; Rixen, D.; Morley, J.; Stiletto, R.; Husbye, E. Ellingsen; Bayeff-Filoff, R.

In: Annals of Surgery, Vol. 246, No. 3, 09.2007, p. 491-499.

Research output: Contribution to journalArticle

Pape, HC, Rixen, D, Morley, J, Husebye, EE, Mueller, M, Dumont, C, Gruner, A, Oestern, HJ, Bayeff-Filoff, M, Garving, C, Pardini, D, Van Griensven, M, Krettek, C, Giannoudis, P, Gruner, A, Wittke, M, Dumont, C, Grimme, K, Mueller, M, Rixen, D, Morley, J, Stiletto, R, Husbye, EE & Bayeff-Filoff, R 2007, 'Impact of the method of initial stabilization for femoral shaft fractures in patients with multiple injuries at risk for complications (borderline patients)', Annals of Surgery, vol. 246, no. 3, pp. 491-499. https://doi.org/10.1097/SLA.0b013e3181485750
Pape, Hans Christoph ; Rixen, Dieter ; Morley, John ; Husebye, Elisabeth Ellingsen ; Mueller, Michael ; Dumont, Clemens ; Gruner, Andreas ; Oestern, Hans Joerg ; Bayeff-Filoff, Michael ; Garving, Christina ; Pardini, Dustin ; Van Griensven, Martijn ; Krettek, Christian ; Giannoudis, Peter ; Gruner, A. ; Wittke, M. ; Dumont, C. ; Grimme, K. ; Mueller, M. ; Rixen, D. ; Morley, J. ; Stiletto, R. ; Husbye, E. Ellingsen ; Bayeff-Filoff, R. / Impact of the method of initial stabilization for femoral shaft fractures in patients with multiple injuries at risk for complications (borderline patients). In: Annals of Surgery. 2007 ; Vol. 246, No. 3. pp. 491-499.
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abstract = "OBJECTIVES: The timing of definitive fixation for major fractures in patients with multiple injuries is controversial. To address this gap, we randomized patients with blunt multiple injuries to either initial definitive stabilization of the femur shaft with an intramedullary nail or an external fixateur with later conversion to an intermedullary nail and documented the postoperative clinical condition. METHODS: Multiply injured patients with femoral shaft fractures were randomized to either initial (16 points, or 3 fractures and Abbreviated Injury Scale score ≥2 points and another injury (Abbreviated Injury Scale score ≥2 points), and age 18 to 65 years. Exclusion: patients in unstable or critical condition. Patients were graded as stable or borderline (increased risk of systemic complications). OUTCOMES: Incidence of acute lung injuries. RESULTS: Ten European Centers, 165 patients, mean age 32.7 ± 11.7 years. Group intramedullary nailing, n = 94; group external fixation, n = 71. Preoperatively, 121 patients were stable and 44 patients were in borderline condition. After adjusting for differences in initial injury severity between the 2 treatment groups, the odds of developing acute lung injury were 6.69 times greater in borderline patients who underwent intramedullary nailing in comparison with those who underwent external fixation, P <0.05. CONCLUSION: Intramedullary stabilization of the femur fracture can affect the outcome in patients with multiple injuries. In stable patients, primary femoral nailing is associated with shorter ventilation time. In borderline patients, it is associated with a higher incidence of lung dysfunctions when compared with those who underwent external fixation and later conversion to intermedullary nail. Therefore, the preoperative condition should be when deciding on the type of initial fixation to perform in patients with multiple blunt injuries.",
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T1 - Impact of the method of initial stabilization for femoral shaft fractures in patients with multiple injuries at risk for complications (borderline patients)

AU - Pape, Hans Christoph

AU - Rixen, Dieter

AU - Morley, John

AU - Husebye, Elisabeth Ellingsen

AU - Mueller, Michael

AU - Dumont, Clemens

AU - Gruner, Andreas

AU - Oestern, Hans Joerg

AU - Bayeff-Filoff, Michael

AU - Garving, Christina

AU - Pardini, Dustin

AU - Van Griensven, Martijn

AU - Krettek, Christian

AU - Giannoudis, Peter

AU - Gruner, A.

AU - Wittke, M.

AU - Dumont, C.

AU - Grimme, K.

AU - Mueller, M.

AU - Rixen, D.

AU - Morley, J.

AU - Stiletto, R.

AU - Husbye, E. Ellingsen

AU - Bayeff-Filoff, R.

PY - 2007/9

Y1 - 2007/9

N2 - OBJECTIVES: The timing of definitive fixation for major fractures in patients with multiple injuries is controversial. To address this gap, we randomized patients with blunt multiple injuries to either initial definitive stabilization of the femur shaft with an intramedullary nail or an external fixateur with later conversion to an intermedullary nail and documented the postoperative clinical condition. METHODS: Multiply injured patients with femoral shaft fractures were randomized to either initial (16 points, or 3 fractures and Abbreviated Injury Scale score ≥2 points and another injury (Abbreviated Injury Scale score ≥2 points), and age 18 to 65 years. Exclusion: patients in unstable or critical condition. Patients were graded as stable or borderline (increased risk of systemic complications). OUTCOMES: Incidence of acute lung injuries. RESULTS: Ten European Centers, 165 patients, mean age 32.7 ± 11.7 years. Group intramedullary nailing, n = 94; group external fixation, n = 71. Preoperatively, 121 patients were stable and 44 patients were in borderline condition. After adjusting for differences in initial injury severity between the 2 treatment groups, the odds of developing acute lung injury were 6.69 times greater in borderline patients who underwent intramedullary nailing in comparison with those who underwent external fixation, P <0.05. CONCLUSION: Intramedullary stabilization of the femur fracture can affect the outcome in patients with multiple injuries. In stable patients, primary femoral nailing is associated with shorter ventilation time. In borderline patients, it is associated with a higher incidence of lung dysfunctions when compared with those who underwent external fixation and later conversion to intermedullary nail. Therefore, the preoperative condition should be when deciding on the type of initial fixation to perform in patients with multiple blunt injuries.

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