Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
European Journal of Trauma and Emergency Surgery
Published in: European Journal of Trauma and Emergency Surgery 1/2018

Open Access 01-02-2018 | Original Article

Two-stage treatment in patients with patients with high-energy femoral fractures does not lead to an increase in deep infectious complications: a propensity score analysis

Authors: S. A. Dingemans, M. A. T. Sier, R. W. Peters, J. C. Goslings, T. Schepers

Published in: European Journal of Trauma and Emergency Surgery | Issue 1/2018

Login to get access

Abstract

Purpose

In patients following severe trauma sometimes the physiological condition or soft tissue status may not allow definitive fixation of a femoral fracture. In these patients, an external fixator can be placed to temporarily stabilise the fracture, after which definitive fixation can be performed in a second procedure. The aim of this study was to compare the postoperative wound infection and union rates of patients treated with direct intramedullary nailing (IMN) and patients treated with the ‘two-stage treatment’.

Methods

All patients with high-energy femoral fractures treated with IMN between 2000 and 2016 in a single Level 1 trauma centre were eligible. Electronic charts were reviewed for patient and surgical characteristics; furthermore, the development of complications was noted. A propensity score analysis was performed to assess the attributed risk of the external fixator on the development of postoperative wound infections.

Results

A total of 149 patients were included in this study; 93 underwent direct IMN and 56 underwent the two-stage treatment. Patients who underwent two-stage treatment were more severely injured, reflected by lower EMV and higher ISS on admission. Patients in the two-stage treatment group had a significant higher risk of postoperative wound infections (OR: 4.698, 95% CI: 1.203–18.339) but not a higher risk on deep postoperative wound infections (OR 2.345, 95% CI: 0.439–12.540). Union rate did not differ between the two groups (94% vs 94% NS).

Conclusions

The two-stage treatment is a safe treatment option in patients with a high-energy femoral fracture in terms of postoperative wound infections. Union rates are also comparable between the two treatment groups.
Literature
1.
Shane E, Burr D, Ebeling PR, Abrahamsen B, Adler RA, Brown TD, et al. Atypical subtrochanteric and diaphyseal femoral fractures: report of a task force of the American society for bone and mineral research. J Bone Miner Res. 2010;25:2267–94.CrossRefPubMed
2.
Bone LB, Johnson KD, Weigelt J, Scheinberg R. Early versus delayed stabilization of femoral fractures. A prospective randomized study. J Bone Joint Surg Am. 1989;71:336–40.CrossRefPubMed
3.
Rüedi TP, Buckley R, Moran CG. AO principles of fracture management. Ann R Coll Surg Engl. 2009;91(5):448–9.
4.
Wyatt JP, Illingworth RN, Graham CA, Hogg K. Oxford handbook of emergency medicine. Oxford: Oxford University Press; 2012.CrossRef
5.
Gustilo RB, Anderson JT. Prevention of infection in the treatment of 1025 open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976;58:453–8.CrossRefPubMed
6.
Templeman DC, Gulli B, Tsukayama DT, Gustilo RB. Update on the management of open fractures of the tibial shaft. Clin Orthop Relat Res. 1998;(350):18–25.
7.
Scalea TM, Boswell SA, Scott JD, Mitchell KA, Kramer ME, Pollak AN. External fixation as a bridge to intramedullary nailing for patients with multiple injuries and with femur fractures: damage control orthopedics. J Trauma. 2000;48:613–23.CrossRefPubMed
8.
Nowotarski PJ, Turen CH, Brumback RJ, Scarboro JM. Conversion of external fixation to intramedullary nailing for fractures of the shaft of the femur in multiply injured patients. J Bone Joint Surg Am. 2000;82:781–8.CrossRefPubMed
9.
Harwood PJ, Giannoudis P V, Probst C, Krettek C, Pape H-C. The risk of local infective complications after damage control procedures for femoral shaft fracture. J Orthop Trauma. 2006;20:181–9.PubMed
10.
Wordsworth M, Lawton G, Nathwani D, Pearse M, Naique S, Dodds A, et al. Improving the care of patients with severe open fractures of the tibia: the effect of the introduction of major trauma networks and national guidelines. Bone Joint J. 2016;98-B:420–4.CrossRefPubMed
11.
Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Hospital infection control practices advisory committee. Infect Control Hosp Epidemiol. 1999;20:250–78.CrossRefPubMed
12.
Olthof DC, Joosse P, Bossuyt PMM, de Rooij PP, Leenen LPH, Wendt KW, et al. Observation versus embolization in patients with blunt splenic injury after trauma: a propensity score analysis. World J Surg. 2016;40:1264–71.CrossRefPubMed
13.
Austin PC. An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav Res. 2011;46:399–424.CrossRefPubMedPubMedCentral
14.
Rixen D, Steinhausen E, Sauerland S, Lefering R, Maegele MG, Bouillon B, et al. Randomized, controlled, two-arm, interventional, multicenter study on risk-adapted damage control orthopedic surgery of femur shaft fractures in multiple-trauma patients. Trials. 2016;17:47.CrossRefPubMedPubMedCentral
15.
Pape H-C, Rixen D, Morley J, Husebye EE, Mueller M, Dumont C, et al. Impact of the method of initial stabilization for femoral shaft fractures in patients with multiple injuries at risk for complications (borderline patients). Ann Surg. 2007;246:491–501.CrossRefPubMedPubMedCentral
16.
Pape H-C, Hildebrand F, Pertschy S, Zelle B, Garapati R, Grimme K, et al. Changes in the management of femoral shaft fractures in polytrauma patients: from early total care to damage control orthopedic surgery. J Trauma. 2002;53:452–62.CrossRefPubMed
17.
Höntzsch D, Weller S, Engels C, Kaiserauer S. Change in the procedure from external fixator to intramedullary nailing osteosynthesis of the femur and tibia. Aktuelle Traumatol. 1993;23(Suppl 1):21–35PubMed
18.
Wolinsky PR, McCarty E, Shyr Y, Johnson K. Reamed intramedullary nailing of the femur: 551 cases. J Trauma. 1999;46:392–9.CrossRefPubMed
19.
20.
Clasper JC, Stapley SA, Bowley DM, Kenward CE, Taylor V, Watkins PE. Spread of infection, in an animal model, after intramedullary nailing of an infected external fixator pin track. J Orthop Res. 2001;19:155–9.CrossRefPubMed
21.
Li A-B, Zhang W-J, Guo W-J, Wang X-H, Jin H-M, Zhao Y-M. Reamed versus unreamed intramedullary nailing for the treatment of femoral fractures: a meta-analysis of prospective randomized controlled trials. Medicine (Baltimore). 2016;95:e4248.CrossRefPubMedPubMedCentral
22.
Morshed S, Miclau T, Bembom O, Cohen M, Knudson MM, Colford JM. Delayed internal fixation of femoral shaft fracture reduces mortality among patients with multisystem trauma. J Bone Joint Surg Am. 2009;91:3–13.CrossRefPubMedPubMedCentral
23.
Scannell BP, Waldrop NE, Sasser HC, Sing RF, Bosse MJ. Skeletal traction versus external fixation in the initial temporization of femoral shaft fractures in severely injured patients. J Trauma. 2010;68:633–40.CrossRefPubMed
24.
Lonjon G, Porcher R, Ergina P, Fouet M, Boutron I. Potential pitfalls of reporting and bias in observational studies with propensity score analysis assessing a surgical procedure: a methodological systematic review. Ann Surg. 2016;265:901–9.CrossRef
25.
Ridgeway S, Wilson J, Charlet A, Kafatos G, Pearson A, Coello R. Infection of the surgical site after arthroplasty of the hip. J Bone Joint Surg Br. 2005;87:844–50.CrossRefPubMed
26.
Kosir R, Moore FA, Selby JH, Cocanour CS, Kozar RA, Gonzalez EA, et al. Acute lower extremity compartment syndrome (ALECS) screening protocol in critically ill trauma patients. J Trauma. 2007;63:268–75.CrossRefPubMed
27.
Knaus WA, Wagner DP, Draper EA, Zimmerman JE, Bergner M, Bastos PG, et al. The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest. 1991;100:1619–36.CrossRefPubMed
Metadata
Title
Two-stage treatment in patients with patients with high-energy femoral fractures does not lead to an increase in deep infectious complications: a propensity score analysis
Authors
S. A. Dingemans
M. A. T. Sier
R. W. Peters
J. C. Goslings
T. Schepers
Publication date
01-02-2018
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 1/2018
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-017-0822-6

Other articles of this Issue 1/2018

European Journal of Trauma and Emergency Surgery 1/2018 Go to the issue

Original Article

Emergency surgery for obstructing colonic cancer: a comparison between right-sided and left-sided lesions

Original Article

End cap versus no end cap in intramedullary nailing for displaced midshaft clavicle fractures: influence on implant-related irritation

Original Article

Reduction of relative centrifugation force within injectable platelet-rich-fibrin (PRF) concentrates advances patients’ own inflammatory cells, platelets and growth factors: the first introduction to the low speed centrifugation concept

Original Article

In vivo knee rotational stability 2 years after double-bundle and anatomic single-bundle ACL reconstruction

Correction

Correction to: Traumatic inferior shoulder dislocation: a review of management and outcome

Original Article

Clinical outcome after alternative treatment of scaphoid fractures and nonunions