Factors influencing management of bilateral femur fractures: A multicenter retrospective cohort of early versus delayed definitive Fixation

•High-volume institutions were found to be the primary driver of variability in management of bilateral femur fractures.•There is considerable variation amongst institutions in timing of definitive surgery for bilateral femur fractures.•ISS is a direct influencer in timing of definitive surgery for...

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Published in:Injury 2021-08, Vol.52 (8), p.2395-2402
Main Authors: Flagstad, Ilexa R., Tatman, Lauren M., Albersheim, Melissa, Heare, Austin, Parikh, Harsh R., Vang, Sandy, Westberg, Jerald R., de Chaffin, Danielle Ries, Schmidt, Tegan, Breslin, Mary, Simske, Natasha, Siy, Alexander B., Lufrano, Reuben C., Rodriguez-Buitrago, Andres F., Labrum, Joseph T., Shaw, Nichole, Only, Arthur J., Nadeau, Jason, Davis, Patrick, Steverson, Barbara, Lund, Erik A., Connelly, Daniel, Atchison, Jared, Mauffrey, Cyril, Hak, David J, Titter, Julie, Feinstein, Shawn, Hahn, Jesse, Sagi, Claude, Whiting, Paul S., Mir, Hassan R., Schmidt, Andrew H., Wagstrom, Emily, Obremskey, William T., O'Toole, Robert V., Vallier, Heather A., Cunningham, Brian
Format: Article
Language:English
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Summary:•High-volume institutions were found to be the primary driver of variability in management of bilateral femur fractures.•There is considerable variation amongst institutions in timing of definitive surgery for bilateral femur fractures.•ISS is a direct influencer in timing of definitive surgery for bilateral femur fractures. The purpose of our study was to evaluate the factors that influence the timing of definitive fixation in the management of bilateral femoral shaft fractures and the outcomes for patients with these injuries. Patients with bilateral femur fractures treated between 1998 to 2019 at ten level-1 trauma centers were retrospectively reviewed. Patients were grouped into early or delayed fixation, which was defined as definitive fixation of both femurs within or greater than 24 hours from injury, respectively. Statistical analysis included reversed logistic odds regression to predict which variable(s) was most likely to determine timing to definitive fixation. The outcomes included age, sex, high-volume institution, ISS, GCS, admission lactate, and admission base deficit. Three hundred twenty-eight patients were included; 164 patients were included in the early fixation group and 164 patients in the delayed fixation group. Patients managed with delayed fixation had a higher Injury Severity Score (26.8 vs 22.4; p
ISSN:0020-1383
1879-0267
DOI:10.1016/j.injury.2021.02.091