Prompt fixation of isolated femur fractures in a rural trauma center: a study examining the timing of fixation and resource allocation.

Early fixation is defined by most authors as fracture fixation within 24 hours of admission. This definition of early is arbitrary and may not be achievable in a rural environment where interhospital transfer is often required and operating room resources are constrained. A review of isolated femur fractures was performed to determine if prompt fixation (24-72 hours, Early) was more effective than late fixation (> 72 hours, Late) and similar to immediate fixation (< 24 hours, Immediate) with regard to complications, mortality, and resource utilization. Between October 1, 1987 and December 31, 1990, 67 patients were admitted and stratified into one of the three groups based on the timing of fixation. The number of emergency operations was significantly greater in the Immediate group and the surgery took significantly longer to perform than in either the Early or Late groups (p < 0.004; ANOVA). There were significantly fewer pulmonary and infectious complications in the Immediate and Early groups compared with the Late group (p < 0.05, chi 2). Fixation of isolated femur fractures after 24 hours but before 72 hours had morbidity similar to fixation within the first 24 hours, but utilized operating room resources more efficiently.