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Current Concepts Review   |    
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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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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