Optimal timing of femur fracture stabilization in polytrauma patients: A practice management guideline from the Eastern Association for the Surgery of Trauma

Rajesh R. Gandhi, Tiffany L. Overton, Elliott Haut, Brandyn Lau, Heather A. Vallier, Thomas Rohs, Erik Anton Hasenboehler, Jane Kayle Lee, Darrell Alley, Jennifer Watters, Frederick B. Rogers, Shahid Shafi

Research output: Contribution to journalArticle

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 (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.

Original languageEnglish (US)
Pages (from-to)787-795
Number of pages9
JournalThe journal of trauma and acute care surgery
Volume77
Issue number5
DOIs
StatePublished - Nov 1 2014

Fingerprint

Multiple Trauma
Practice Management
Practice Guidelines
Femur
Venous Thromboembolism
Wounds and Injuries
Closed Fractures
Odds Ratio
Confidence Intervals
Mortality
Software
Infection
Internal Fracture Fixation
Intramedullary Fracture Fixation
Meta-Analysis

Keywords

  • Delayed fixation
  • Early fixation
  • Fracture fixation
  • Long bone stabilization
  • Timing fixation

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Optimal timing of femur fracture stabilization in polytrauma patients : A practice management guideline from the Eastern Association for the Surgery of Trauma. / Gandhi, Rajesh R.; Overton, Tiffany L.; Haut, Elliott; Lau, Brandyn; Vallier, Heather A.; Rohs, Thomas; Hasenboehler, Erik Anton; Lee, Jane Kayle; Alley, Darrell; Watters, Jennifer; Rogers, Frederick B.; Shafi, Shahid.

In: The journal of trauma and acute care surgery, Vol. 77, No. 5, 01.11.2014, p. 787-795.

Research output: Contribution to journalArticle

Gandhi, Rajesh R. ; Overton, Tiffany L. ; Haut, Elliott ; Lau, Brandyn ; Vallier, Heather A. ; Rohs, Thomas ; Hasenboehler, Erik Anton ; Lee, Jane Kayle ; Alley, Darrell ; Watters, Jennifer ; Rogers, Frederick B. ; Shafi, Shahid. / Optimal timing of femur fracture stabilization in polytrauma patients : A practice management guideline from the Eastern Association for the Surgery of Trauma. In: The journal of trauma and acute care surgery. 2014 ; Vol. 77, No. 5. pp. 787-795.
@article{ce19dd26db4744bd9feeeb032d33c342,
title = "Optimal timing of femur fracture stabilization in polytrauma patients: A practice management guideline from the Eastern Association for the Surgery of Trauma",
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 (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.",
keywords = "Delayed fixation, Early fixation, Fracture fixation, Long bone stabilization, Timing fixation",
author = "Gandhi, {Rajesh R.} and Overton, {Tiffany L.} and Elliott Haut and Brandyn Lau and Vallier, {Heather A.} and Thomas Rohs and Hasenboehler, {Erik Anton} and Lee, {Jane Kayle} and Darrell Alley and Jennifer Watters and Rogers, {Frederick B.} and Shahid Shafi",
year = "2014",
month = "11",
day = "1",
doi = "10.1097/TA.0000000000000434",
language = "English (US)",
volume = "77",
pages = "787--795",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

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

AU - Lau, Brandyn

AU - Vallier, Heather A.

AU - Rohs, Thomas

AU - Hasenboehler, Erik Anton

AU - Lee, Jane Kayle

AU - Alley, Darrell

AU - Watters, Jennifer

AU - Rogers, Frederick B.

AU - Shafi, Shahid

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

UR - http://www.scopus.com/inward/record.url?scp=84925872124&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84925872124&partnerID=8YFLogxK

U2 - 10.1097/TA.0000000000000434

DO - 10.1097/TA.0000000000000434

M3 - Article

C2 - 25494434

AN - SCOPUS:84925872124

VL - 77

SP - 787

EP - 795

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 5

ER -