In-Hospital Morbidity and Mortality With Delays in Femoral Shaft Fracture Fixation

Objectives: To investigate trends in the timing of femur fracture fixation in trauma centers in the United States, identify predictors for delayed treatment, and analyze the association of timing of fixation with in-hospital morbidity and mortality using data from the National Trauma Data Bank. Methods: Patients with femoral shaft fractures treated from 2007 to 2015 were identified from the National Trauma Data Bank and grouped by timing of femur fixation:,24, 24–48 hours, and .48 hours after hospital presentation. The primary outcome measure was in-hospital postoperative mortality rate. Secondary outcomes included complication rates, hospital length of stay (LOS), days spent in the intensive care unit LOS (ICU LOS), and days on a ventilator. Results: Among the 108,825 unilateral femoral shaft fractures identified, 74.2% was fixed within 24 hours, 16.5% between 24 and 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 [odds ratio (OR) 3.60; 95% confidence interval (CI), 3.13–4.14], longer LOS (OR 2.14; CI 2.06–2.22), longer intensive care unit 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). Conclusions: 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 of increased morbidity and mortality. Although some patients require optimization/resuscitation before fracture fixation, efforts should be made to expedite operative fixation.