Higher Education | Medicine and Health Sciences
Abstract: Injuries capable of fracturing the femur often involve concurrent internal organ damage. However, up to 25% of injuries are initially missed. Prior studies evaluating the association of femur fractures with internal injury included only automobile trauma, were skewed toward more severe injuries, and were broad database studies. To our knowledge, there are no studies of this kind that include bicycle, motorcycle, and motor vehicle-pedestrian trauma, excluding those deceased at the scene, and which included chart reviews. We hypothesized that in the trauma setting, the presence of a femur fracture would correlate with an increase in concomitant internal organ injuries. Data was retrospectively queried from two Level I Trauma Centers. Patients presenting between January 1, 2005 and December 31, 2012 with trauma activation met inclusion criteria. Patients were stratified based on presence of a femur fracture, open/closed fracture status, and shaft versus non-shaft fractures. Internal organ injuries were documented. Logistic regression analysis was used to determine if the presence of a femur fracture, open fractures, or shaft fractures were predictive of internal injuries. Results were reported as odds ratios with 95% confidence intervals (CI). A p-value < 0.05 was statistically significant. Femur fracture and open fracture were associated with additional internal injury. Shaft fractures were not associated with additional injury. Subjects ≤18 years with femur fracture were more likely to sustain additional injury compared to older age groups. The current study reveals that fractures of the femur in this setting may be associated with additional internal injuries. Open fractures may portend more severe organ injury compared to closed fractures. Femoral fracture in age ≥65 may not be as predictive for associated internal injuries. Development of a standardized grading system may aid in alerting the provider to the potential for these life-threatening injuries. Level of evidence: IV.
femoral, femur, fracture, internal injury, organ, trauma
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Miller, R. E., Olinger, C., Grossman, L., Chakkalakal, D., Bergmann, K., Lyden, E., , Siebler, J. A Retrospective Study at Two Level One Trauma Centers on the Association of Internal Injuries with Femoral Fractures. Graduate Medical Education Research Journal. 2019 Dec 13; 1(1).