The goals of this study were to investigate trends in the timing to femur fracture fixation in trauma centers in the United States, identify predictors for delayed treatment, and analyze the association of timing to fixation with in-hospital morbidity and mortality using data from the National Trauma Data Bank (NTDB).
Patients with femoral shaft fractures treated from 2007-2015 were identified from the NTDB, and grouped by timing of femur fixation: <24 hours, 24-48 hours, and >48 hours after hospital presentation. The primary outcome measure was in-hospital postoperative mortality rate. Secondary outcomes included complication rates, length of hospital stay (LOS), days spent in the intensive care unit (ICU LOS), and days on a ventilator.
Among the 108,825 unilateral femoral shaft fractures identified, 74.2% were fixed within 24 hours, 16.5% between 24-48 hours, and 9.4% >48 hours. The mortality rate was 1.6% overall for the group. When fixation was delayed >48 hours, patients were at risk of significantly higher mortality rate (OR 3.60; 95% confidence interval [CI], 3.13-4.14), longer LOS (OR 2.14; CI 2.06-2.22), longer ICU LOS (OR 3.92; CI 3.66-4.20), more days on a ventilator (OR 5.38; CI 4.89-5.91), and more postoperative complications (OR 2.05; CI 1.94-2.17; p<0.0001).
Our study confirms that delayed fixation of femoral shaft fractures is associated with increased patient morbidity and mortality. Patients who underwent fixation >48 hours after presentation were at the greatest risk for increased morbidity and mortality. Although some patients require optimization/resuscitation prior to fracture fixation, efforts should be made to expedite operative fixation.
Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.