TY - JOUR
T1 - A Comparison of the Prevalence of, Demographics of, and Effects on Outcomes of Bilateral Versus Unilateral Femoral Shaft Fractures
T2 - A Retrospective Cohort Analysis From the National Trauma Data Bank
AU - Cosgrove, Christopher T.
AU - Wolinsky, Philip R.
AU - Berkes, Marschall B.
AU - Mcandrew, Christopher M.
AU - Stwalley, Dustin L.
AU - Miller, Anna N.
N1 - Funding Information:
Center for Administrative Data Research is supported in part by the Washington University Institute of Clinical and Translational Sciences grant UL1 TR002345 from the National Center for Advancing Translational Sciences (NCATS).
Funding Information:
Statistical analysis and data support were provided by the Center for Administrative Data Research, which is supported in part by the Washington University Institute of Clinical and Translational Sciences Grant UL1 TR002345 from the National Center for Advancing Translational Sciences of the National Institutes of Health and Grant Number R24 HS19455 through the Agency for Healthcare Research and Quality.
Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.
PY - 2022/7/1
Y1 - 2022/7/1
N2 - Objectives:To document the prevalence of, and the effect on outcomes, operatively treated bilateral femur fractures treated using contemporary treatments.Design:A retrospective cohort using data from the National Trauma Data Bank.Participants:In total, 119,213 patients in the National Trauma Data Bank between the years 2007 and 2015 who had operatively treated femoral shaft fractures.Main Outcome Measurements:Complication rates, hospital length of stay (LOS), days in the intensive care unit (ICU LOS), days on a ventilator, and mortality rates.Results:Patients with bilateral femur fractures had increased overall complications (0.74 vs. 0.50, P < 0.0001), a longer LOS (14.3 vs. 9.2, P < 0.0001), an increased ICU LOS (5.3 vs. 2.4, P < 0.0001), and more days on a ventilator (3.1 vs. 1.3, P < 0.0001), when compared with unilateral fractures. Bilateral femoral shaft fractures were independently associated with worse outcomes in all primary domains when adjusted by Injury Severity Score (P < 0.0001), apart from mortality rates. Age-adjusted bilateral injuries were independently associated with worse outcomes in all primary domains (P < 0.0001) except for the overall complication rate. A delay in fracture fixation beyond 24 hours was associated with increased mortality (P < 0.0001) and worse outcomes for all other primary measures (P < 0.0001 to P = 0.0278) for all patients.Conclusions:Bilateral femoral shaft fractures are an independent marker for increased hospital and ICU LOS, number of days on a ventilator, and increased complication rates, when compared with unilateral injuries and adjusted for age and Injury Severity Score. Timely definitive fixation, in a physiologically appropriate patient, is critical because a delay is associated with worse inpatient outcome measures and higher mortality rates.Level of Evidence:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
AB - Objectives:To document the prevalence of, and the effect on outcomes, operatively treated bilateral femur fractures treated using contemporary treatments.Design:A retrospective cohort using data from the National Trauma Data Bank.Participants:In total, 119,213 patients in the National Trauma Data Bank between the years 2007 and 2015 who had operatively treated femoral shaft fractures.Main Outcome Measurements:Complication rates, hospital length of stay (LOS), days in the intensive care unit (ICU LOS), days on a ventilator, and mortality rates.Results:Patients with bilateral femur fractures had increased overall complications (0.74 vs. 0.50, P < 0.0001), a longer LOS (14.3 vs. 9.2, P < 0.0001), an increased ICU LOS (5.3 vs. 2.4, P < 0.0001), and more days on a ventilator (3.1 vs. 1.3, P < 0.0001), when compared with unilateral fractures. Bilateral femoral shaft fractures were independently associated with worse outcomes in all primary domains when adjusted by Injury Severity Score (P < 0.0001), apart from mortality rates. Age-adjusted bilateral injuries were independently associated with worse outcomes in all primary domains (P < 0.0001) except for the overall complication rate. A delay in fracture fixation beyond 24 hours was associated with increased mortality (P < 0.0001) and worse outcomes for all other primary measures (P < 0.0001 to P = 0.0278) for all patients.Conclusions:Bilateral femoral shaft fractures are an independent marker for increased hospital and ICU LOS, number of days on a ventilator, and increased complication rates, when compared with unilateral injuries and adjusted for age and Injury Severity Score. Timely definitive fixation, in a physiologically appropriate patient, is critical because a delay is associated with worse inpatient outcome measures and higher mortality rates.Level of Evidence:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
KW - bilateral femoral shaft fractures
KW - femoral shaft fracture
KW - mortality
KW - polytrauma
UR - http://www.scopus.com/inward/record.url?scp=85132310941&partnerID=8YFLogxK
U2 - 10.1097/BOT.0000000000002322
DO - 10.1097/BOT.0000000000002322
M3 - Article
C2 - 35727002
AN - SCOPUS:85132310941
SN - 0890-5339
VL - 36
SP - 349
EP - 354
JO - Journal of orthopaedic trauma
JF - Journal of orthopaedic trauma
IS - 7
ER -