Thoracic trauma and early intramedullary nailing of femur fractures: are we doing harm?

Background: It has been reported that early intramedullary nailing (IMN) of a femur fracture in the presence of thoracic injury increases morbidity and mortality. The purpose of the present study was to determine if IMN < or = 24 hours after multisystem injury (Injury Severity Score (ISS) > 16) is associated with a poor hospital outcome in the presence of blunt thoracic trauma (Abbreviated Injury Scale (AIS) thorax score > or = 2).

Methods: Retrospective cohort study at a single adult trauma center.

Results: In a 6-year period, 149 blunt trauma patients had both an ISS > 16 and a femur fracture managed by IMN. These 149 patients were divided into four groups based on thoracic injury (T = AIS thorax score > or = 2; N = AIS thorax score < 2) and the timing of IMN (E = < or = 24 hours; L = > 24 hours). There were 68 TE, 57 NE, 15 TL, and 9 NL patients. The TE and NE groups were similar in age and ISS. TE and NE groups had similar durations of ventilation, critical care, hospital stay, and mortality. Furthermore, TE patients were no more likely to be intubated after IMN than NE patients. TE patients were matched with similar patients without a femur fracture and found to have similar hospital outcomes.

Conclusions: This study has not demonstrated an increased morbidity or mortality associated with early IMN in the presence of thoracic trauma.