TY - JOUR
T1 - Optimal timing of femur fracture stabilization in polytrauma patients
T2 - A practice management guideline from the Eastern Association for the Surgery of Trauma
AU - Gandhi, Rajesh R.
AU - Overton, Tiffany L.
AU - Haut, Elliott R.
AU - Lau, Brandyn
AU - Vallier, Heather A.
AU - Rohs, Thomas
AU - Hasenboehler, Erik
AU - Lee, Jane Kayle
AU - Alley, Darrell
AU - Watters, Jennifer
AU - Rogers, Frederick B.
AU - Shafi, Shahid
N1 - Publisher Copyright:
Copyright © 2014 by Lippincott Williams & Wilkins).
PY - 2014/11/1
Y1 - 2014/11/1
N2 - 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 (G24 hours) versus late (924 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 (G24 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.
AB - 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 (G24 hours) versus late (924 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 (G24 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.
KW - Delayed fixation
KW - Early fixation
KW - Fracture fixation
KW - Long bone stabilization
KW - Timing fixation
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U2 - 10.1097/TA.0000000000000434
DO - 10.1097/TA.0000000000000434
M3 - Article
AN - SCOPUS:84925872124
SN - 2163-0755
VL - 77
SP - 787
EP - 795
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 5
ER -