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Archives of Orthopaedic and Trauma Surgery

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01-07-2021 | Femoral Fracture | Trauma Surgery

Femoral fractures are an indicator of increased severity of injury for road traffic collision victims: an autopsy–based case–control study on 4895 fatalities

Authors: Leonidas Roumeliotis, Nikolaos K. Kanakaris, Vasileios S. Nikolaou, Nikolaos Danias, Georgios Konstantoudakis, Iordanis N. Papadopoulos

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 10/2022

Abstract

Introduction

The course of road traffic collision (RTC) victims with femoral fractures (FFx) from injury to death was reviewed. We sought to correlate the presence of femoral fractures with the overall severity of injury from RTCs using objective indices and to identify statistically significant associations with injuries in other organs.

Patients and methods

A case–control study based on forensic material from 4895 consecutive RTC-induced fatalities, between 1996 and 2005. Injuries were coded according to the Abbreviated Injury Scale-1990 Revision (AIS-90), and the Injury Severity Score (ISS) was calculated. Victims were divided according to the presence of femoral fractures in all possible anatomic locations or not. Univariate comparisons and logistic regression analysis for probabilities of association as odds ratios (OR) were performed.

Results

The FFx group comprised 788 (16.1%) victims. The remaining 4107 victims constituted the controls. The FFx group demonstrated higher ISS (median 48 vs 36, p < 0.001) and shorter post-injury survival times (median 60 vs 85 min, p < 0.001). Presence of bilateral fractures (15.5%) potentiated this effect (median ISS 50 vs 43, p = 0.006; median survival time 40 vs 65, p = 0.0025; compared to unilateral fractures). Statistically significant associations of FFx were identified with AIS2-5 thoracic trauma (OR 1.43), AIS2-5 abdominal visceral injuries (OR 1.89), AIS1-3 skeletal injuries of the upper (OR 2.7) and lower limbs (OR 3.99) and AIS2-5 of the pelvis (OR 2.75) (p < 0.001). In the FFx group, 218 (27.7%) victims survived past the emergency department and 116 (53.2%) underwent at least one surgical procedure. Complications occurred in 45.4% of hospitalized victims, the most common being pneumonia (34.8%).

Conclusion

This study has documented that femoral fractures are associated with increased severity of injury, shorter survival times and higher incidence of associated thoracic, abdominal and skeletal extremity injuries, compared to controls. These findings should be considered for an evidence-based upgrading of trauma care.

Graphic abstract

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Title: Femoral fractures are an indicator of increased severity of injury for road traffic collision victims: an autopsy–based case–control study on 4895 fatalities
Authors: Leonidas Roumeliotis
Nikolaos K. Kanakaris
Vasileios S. Nikolaou
Nikolaos Danias
Georgios Konstantoudakis
Iordanis N. Papadopoulos
Publication date: 01-07-2021
Publisher: Springer Berlin Heidelberg
Keywords: Femoral Fracture
Autopsy
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 10/2022
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-021-03997-8

At a glance: The STEP trials

Springer Medicine

Femoral fractures are an indicator of increased severity of injury for road traffic collision victims: an autopsy–based case–control study on 4895 fatalities

Abstract

Introduction

Patients and methods

Results

Conclusion

Graphic abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Patients and methods

Results

Conclusion

Graphic abstract

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