Study of Morbidity and Mortality after Intramedullary Nailing of Diaphyseal Femoral Fractures in Polytrauma Patients According to Iss

Introduction: Literature is contradictory on the technique of emergency fixation of femoral diaphyseal fractures of polytrauma. Currently, choice is based on the ISS(Injury-Severity-Score). Intramedullary nailing(IN) is proposed when ISS25. Between 16 and 25,the technique is discussed. We practice IN even if ISS>25.

The objective is to evaluate early and late complications after IN between ISS categories(<16,16-25,>25).

Methods: We analyzed a retrospective consecutive cohort of 191patients(Mean follow-up:18months). IN was performed first day. 62patients had an ISS<16(Group A),80 an ISS between 16 and 25(Group B),49 an ISS>25(Group C). We evaluated early(ARDS,surgical site infection(SSI),pulmonary embolism,leg syndrom) and late complications(nonunions). Correlation analyzes were performed using Pearson test.

Results: Mean ISS was 20.7[9-75]. Rates of ARDS and SSI were statistically correlated with ISS, respectively: Group A,1.6%(n=1);1.6%(n=1)/Group B,3.8%(n=3);3.8%(n=3)/Group C,20.4%(n=10);20.4%(n=10),p15(n=129):mean ISS was 25.5, 10.1%(n=13) developed ARDS and 10.1% developed SSI. SSI in group C were related to fractures with associated vascular, nerve or bone injury. All cured after appropriate treatment. 5 nonunions have been reported. No correlation were found between other complications and ISS.

Conclusion: To compare to literature, an ISS>15 group (Mean ISS=25.5) was extracted. Rate of ARDS reported post-DCO varies from 10%to20.9%(10.1% in our series). Rate of SSI post-DCO is 11.7%vs10.1% in our series. No studies report the rate of nonunion post-DCO.

Early IN of femoral diaphyseal fractures is justified for polytrauma patients with ISS