Rajesh R Gandhi1, Tiffany L Overton, Elliott R Haut, Brandyn Lau, Heather A Vallier, Thomas Rohs, Erik Hasenboehler, Jane Kayle Lee, Darrell Alley, Jennifer Watters, Frederick B Rogers, Shahid Shafi. 1. From the Department of Surgery (R.R.G., T.L.O., S.S.), JPS Health Network, Fort Worth; and Department of Surgery (D.A.), East Texas Medical Center, Tyler, Texas; Departments of Surgery (E.R.H., B.L.), and Orthopaedic Surgery (E.H.), The Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Orthopaedics (H.A.V.), MetroHealth, Cleveland, Ohio; Department of Surgery (T.R.), Borgess Health, Kalamazoo, Michigan; Department of Surgery (J.K.L.), Advocate Medical Group, Chicago, Illinois; Department of Surgery (J.W.), Oregon Health and Science University, Portland, Oregon; and Department of Trauma and Acute Care Surgery (F.B.R.), Lancaster General Health, Lancaster, Pennsylvania.
Abstract
BACKGROUND: Femur fractures are common among trauma patients and are typically seen in patients with multiple injuries resulting from high-energy mechanisms. Internal fixation with intramedullary nailing is the ideal method of treatment; however, there is no consensus regarding the optimal timing for internal fixation. We critically evaluated the literature regarding the benefit of early (<24 hours) versus late (>24 hours) open reduction and internal fixation of open or closed femur fractures on mortality, infection, and venous thromboembolism (VTE) in trauma patients. METHODS: A subcommittee of the Practice Management Guideline Committee of the Eastern Association for the Surgery of Trauma conducted a systematic review and meta-analysis for the earlier question. RevMan software was used to generate forest plots. Grading of Recommendations, Assessment, Development, and Evaluations methodology was used to rate the quality of the evidence, using GRADEpro software to create evidence tables. RESULTS: No significant reduction in mortality was associated with early stabilization, with a risk ratio (RR) of 0.74 (95% confidence interval [CI], 0.50-1.08). The quality of evidence was rated as "low." No significant reduction in infection (RR, 0.4; 95% CI, 0.10-1.6) or VTE (RR, 0.63; 95% CI, 0.37-1.07) was associated with early stabilization. The quality of evidence was rated "low." CONCLUSION: In trauma patients with open or closed femur fractures, we suggest early (<24 hours) open reduction and internal fracture fixation. This recommendation is conditional because the strength of the evidence is low. Early stabilization of femur fractures shows a trend (statistically insignificant) toward lower risk of infection, mortality, and VTE. Therefore, the panel concludes the desirable effects of early femur fracture stabilization probably outweigh the undesirable effects in most patients.
BACKGROUND: Femur fractures are common among traumapatients and are typically seen in patients with multiple injuries resulting from high-energy mechanisms. Internal fixation with intramedullary nailing is the ideal method of treatment; however, there is no consensus regarding the optimal timing for internal fixation. We critically evaluated the literature regarding the benefit of early (<24 hours) versus late (>24 hours) open reduction and internal fixation of open or closed femur fractures on mortality, infection, and venous thromboembolism (VTE) in traumapatients. METHODS: A subcommittee of the Practice Management Guideline Committee of the Eastern Association for the Surgery of Trauma conducted a systematic review and meta-analysis for the earlier question. RevMan software was used to generate forest plots. Grading of Recommendations, Assessment, Development, and Evaluations methodology was used to rate the quality of the evidence, using GRADEpro software to create evidence tables. RESULTS: No significant reduction in mortality was associated with early stabilization, with a risk ratio (RR) of 0.74 (95% confidence interval [CI], 0.50-1.08). The quality of evidence was rated as "low." No significant reduction in infection (RR, 0.4; 95% CI, 0.10-1.6) or VTE (RR, 0.63; 95% CI, 0.37-1.07) was associated with early stabilization. The quality of evidence was rated "low." CONCLUSION: In traumapatients with open or closed femur fractures, we suggest early (<24 hours) open reduction and internal fracture fixation. This recommendation is conditional because the strength of the evidence is low. Early stabilization of femur fractures shows a trend (statistically insignificant) toward lower risk of infection, mortality, and VTE. Therefore, the panel concludes the desirable effects of early femur fracture stabilization probably outweigh the undesirable effects in most patients.
Authors: Mitchel R Obey; David C Clever; Daniel A Bechtold; Dustin Stwalley; Christopher M McAndrew; Marschall B Berkes; Philip R Wolinsky; Anna N Miller Journal: J Orthop Trauma Date: 2022-05-01 Impact factor: 2.884
Authors: Ayman El-Menyar; Mohammed Muneer; David Samson; Hassan Al-Thani; Ahmad Alobaidi; Paul Mussleman; Rifat Latifi Journal: J Orthop Surg Res Date: 2018-06-28 Impact factor: 2.359