TY  - JOUR
T1  - Femoral Shaft Fracture Fixation and Chest Injury After Polytrauma
AU  - Bone, Lawrence B.
AU  - Giannoudis, Peter
Y1  - 2011/02/02
N1  - 10.2106/JBJS.J.00334
JO  - The Journal of Bone & Joint Surgery
SP  - 311
EP  - 317
VL  - 93
IS  - 3
N2  - 
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.

SN  - 0021-9355
M3  - doi: 10.2106/JBJS.J.00334
UR  - http://dx.doi.org/10.2106/JBJS.J.00334
ER  -