MORTALITY IN PATIENTS WITH BILATERAL FEMORAL FRACTURES

Objectives: To determine and compare the mortality rates of patients w ith bilateral versus unilateral femoral fractures and to determine the contribution of the femoral fracture to, and identify risk factors fo r, such mortality. Study Design: Retrospective analysis using trauma r egistry data on consecutive blunt trauma patients with unilateral (800 patients, group I) or bilateral (eighty-five patients, group II) femo ral fractures. Methods: Univariate data analysis was performed to comp are the groups' ages, Injury Severity Scores, Glasgow Coma Scale value s, mortality, and the presence of adult respiratory distress syndrome (ARDS). Logistic regression analysis was performed to determine variab les statistically associated with mortality. Results: Group II patient s had a significantly higher Injury Severity Score (30.2 versus 24.5, p < 0.001), lower Glasgow Coma Scale value (12.3 versus 13.1, p = 0.05 ), higher mortality rate (25.9 vs 11.7%, p < 0.001), and higher incide nce of ARDS (15.7 versus 7.27%, p = 0.014) than group I patients. Grou p II patients also had significantly more closed head injuries, open s kull fractures, intraabdominal injuries requiring surgical interventio n, and pelvic fractures; the rates of thoracic injury were similar. Re gression analysis of variables evident on admission revealed a signifi cant correlation between bilateral femoral fractures and death; howeve r, other factors (shock, closed head injury, and thoracic injury) had much stronger correlations with mortality. Conclusions: Patients with bilateral femoral fractures have a significantly higher risk of death, ARDS, and associated injuries than patients with unilateral femoral f ractures. This increase in mortality is more closely related to associ ated injuries and physiologic parameters than to the presence of bilat eral femoral fractures. The presence of bilateral femoral fractures sh ould alert the clinician to the likelihood of associated injuries, a h igher Injury Severity Score, and the potential for a more serious prog nosis.