THE EFFECT OF A FEMORAL FRACTURE ON CONCOMITANT CLOSED-HEAD INJURY INPATIENTS WITH MULTIPLE INJURIES

Objective: We sought to determine the effect of a femoral shaft fractu re, and its treatment by early intramedullary nailing, on the neurolog ic outcome of patients with multiple injuries with a concomitant head injury. Design: Retrospective, case-control design using a prospective ly gathered trauma data base. Materials and Methods: We identified 46 patients with multiple injuries (mean Injury Severity Score [ISS] = 33 .2) with closed head injuries (mean Glasgow Coma Scale [GCS] score = 7 .8) and femur fractures, and matched as controls 99 patients with mult iple injuries with head injuries but without femur fractures for age, sex, mechanism of injury, ISS (mean ISS = 34.0), and GCS (mean GCS sco re = 8.0). Follow-up parameters examined included early mortality, len gth of hospital or intensive-care unit stay, neuropsychological testin g, and level of neurologic disability. Results: There were no signific ant differences in the demographics or injury parameters between the s tudy and control groups. There were no significant differences between the two groups in terms of early mortality (study group, 28%; control group, 27%; p = not significant), length of hospital/intensive-care u nit stay (study group, 17.5/6.9 days; control group, 18.0/6.3 days; p = not significant), level of neurologic disability, or results of cogn itive testing. Conclusion: Our study suggests that a femoral fracture in a patient with a concomitant head injury does not increase mortalit y or neurologic disability, and supports the continued early intramedu llary nailing of femoral fractures for these patients.