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Femoral Shaft Fracture Fixation and Chest Injury After Polytrauma
Lawrence B. Bone, MD1; Peter Giannoudis, MD, FRCS2
1 Erie County Medical Center, 462 Grider Street, Buffalo, NY 14215
2 Leeds General Infirmary, Great George Street, Clarendon Wing LGIF1A, Leeds LS13EX, United Kingdom
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Feb 02;93(3):311-317. doi: 10.2106/JBJS.J.00334
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Thirty years ago, the standard of care for the multiply injured patient with fractures was placement of the fractured limb in a splint or skeletal traction, until the patient was considered stable enough to undergo surgery for fracture fixation1. This led to a number of complications2, such as adult respiratory distress syndrome (ARDS), infection, pneumonia, malunion, nonunion, and death, particularly when the patient had a high Injury Severity Score (ISS)3. Retrospective studies showed that the incidence of fat embolism syndrome could be reduced with stabilization of long-bone fractures in a multiply injured patient. Riska et al. noted a decrease in fat embolism syndrome from 22% (twenty-one of ninety-five) with traction treatment to 1% (one of ninety-five) with early operative fracture stabilization4. This finding led to greater use of early surgical stabilization of femoral fractures in the multiply injured patient. Subsequent follow-up studies demonstrated decreases in mortality and morbidity with early surgical stabilization of long-bone fractures in the multiply injured patient5-9. Moreover, retrospective noncontrolled studies showed that the patients with the highest ISS or greatest number of injuries derived more benefit from surgical stabilization of a femoral fracture shortly after the injury than from treatment with skeletal traction for seven to ten days prior to operative femoral fixation. Border et al.5 and Johnson et al.6 showed a decrease in pulmonary failure, time on a ventilator, time in the intensive care unit, septic complications, and death with early surgical stabilization.
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