TREATMENT OF FEMUR FRACTURE WITH ASSOCIATED HEAD-INJURY

Objectives: The aim of this study was to determine ia) whether delay i n femur fracture stabilization beyond twenty-four hours in patients wi th head injury increased the risk of pulmonary complications and (b) w hether immediate (up to twenty-four hours) femur fracture stabilizatio n increased the risk of central nervous system (CNS) complications. De sign: Retrospective analysis. Materials and Methods: Thirty-two patien ts with femur fracture and head injury were identified. Fourteen under went immediate sta bilization of their fractures, and eighteen underwe nt delayed (fourteen patients) or no (four patients) stabilization of their fractures. Results: In the immediate stabilization group, five p atients had severe head injuries [Glasgow Coma Scan (GCS) less than or equal to 8] and nine had mild head injuries (GCS > 8). In the mild he ad injury group, no patient had a pulmonary complication and one had a CNS complication. In the severely head-injured group, one patient had a pulmonary complication and no patient had a CNS complication. In th e delayed stabilization group, six patients had mild head injuries (GC S > 8) and twelve had severe head injuries (GCS less than or equal to 8). In the mildly head injured group, one patient had a pulmonary comp lication, two patients had CNS complications, and one patient died. In the severely head injured group, nine patients had pulmonary complica tions, three patients had CNS complications, and one patient died. Log istic regression identified delay in femur stabilization as the strong est predictor of pulmonary complication (p = 0.0042), followed by seve rity of chest Abbreviated Injury Score (AIS; p = 0.0057) and head AIS (p = 0.0133). Delaying fracture stabilization made pulmonary complicat ions forty-five times more likely. Each point increase in the chest AI S and head/neck AIS increased the risk of pulmonary complication by 30 0 percent and 500 percent, respectively. A statistically significant p redictor of CNS complications could not be identified by using logisti c regression. Conclusion: Delay in stabilization of femur fracture in head-injured patients appears to increase the risk of pulmonary compli cations. However, due to selection bias in this patient sample, this q uestion cannot be definitively answered. Early fracture stabilization did not increase the prevalence of CNS complications.