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J Orthop Trauma. 2011 Sep;25(9):556-9. doi: 10.1097/BOT.0b013e318206cd06.

Use of femoral shaft fracture classification for predicting the risk of associated injuries.

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  • 1Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds, UK.

Abstract

OBJECTIVES:

To investigate the hypothesis that specific fracture patterns in patients with femoral shaft fractures can predict the likelihood of associated injuries.

DESIGN:

Retrospective cohort study.

SETTING:

Level I trauma center.

PATIENTS/PARTICIPANTS:

Consecutive patients treated because of a traumatic diaphyseal femoral fracture.

MAIN OUTCOME MEASUREMENT:

We studied the association between the Orthopaedic Trauma Association (OTA) fracture classification (derived from initial radiographs) and concomitant injuries of the head, spine, chest, abdomen, and pelvis with a severity of two or more points according to the Abbreviated Injury Scale by logistic regression analysis.

RESULTS:

One hundred forty-three of 203 patients (80 men, 63 women; mean age 54 ± 26 years) met the inclusion criteria. All patients had unilateral diaphyseal fractures, 64 OTA 32.A (45%), 46 OTA 32.B (32%), and 33 OTA 32.C (23%). In addition, 134 associated injuries were identified in 52 patients. Increasing fracture severity, as expressed by the OTA classification (ie, A, B, C), was significantly associated with a higher likelihood of thoracic (odds ratio [OR], 5.89; 95% confidence interval [CI], 2.59-13.40), pelvic (OR, 4.55; 95% CI, 2.01-10.28), upper (OR, 2.38; 95% CI, 1.27-4.48), and lower extremity injuries (OR, 3.12; 95% CI, 1.78-5.46). Fracture severity explained between 70% and 86% of the probability of having accompanying injuries.

CONCLUSION:

Radiographic grading of the severity of a femoral shaft fracture may signal the presence of accompanying injuries and should contribute to the clinical decision-making process in severe trauma.

PMID:
21857424
[PubMed - indexed for MEDLINE]
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