TREATMENT OF FEMORAL FRACTURES IN THE MULTIPLY INJURED PATIENT WITH THORACIC INJURY

Early fracture fixation in the multiply injured patient has been shown to reduce morbidity and mortality, This premise recently has been que stioned when the multiply injured patient has a pulmonary contusion, a nd also has a femoral fracture stabilized with a reamed intramedullary nail, This put into question whether early stabilization of femoral f ractures, especially with a reamed intramedullary nail, should be perf ormed in patients with a pulmonary contusion, A review of the most rec ent clinical and animal research was performed to help answer this que stion, This review has revealed that the incidence of pulmonary failur e and adult respiratory distress syndrome in multiply injured patients with thoracic injuries who have femoral fractures treated acutely is less than 3%, The morbidity associated with patients with pulmonary co ntusions is independent of the treatment of the femoral fracture, No d ifference in the rate of pulmonary failure is found with reamed nails or plate fixation, The pulmonary failure seems to be secondary to the pulmonary contusion, not to the method of fracture fixation.