PRIMARY INTRAMEDULLARY FEMUR FIXATION IN MULTIPLE TRAUMA PATIENTS WITH ASSOCIATED LUNG CONTUSION—A CAUSE OF POSTTRAUMATIC ARDS?

We investigated whether primary (18, femoral midshaft fracture treated by intramedullary nailing, primary admission or referral within 8 hours after injury, and no death from head injury or hemorrhagic shock. Two groups were differentiated according to the presence or absence of chest trauma (severe chest trauma = AIS thorax >, group T; no severe chest trauma = AIS thorax < 2, group N). Selection of subgroups according to the time of femur stabilization was group I 24 hours after trauma. Injury Severity Scores in the four groups were TI29.4 (n = 24); TII 31.4 (n = 26); NI 20.1 (n = 33); NII 25.4 (n = 23). In patients without thoracic trauma the ICU time (NI7.3 days; NII18.0 days) and intubation time (NI5.5 days; NII11.0 days) were lower in the patients treated primarily (p < 0.05). In patients with severe chest trauma there was a higher incidence of posttraumatic ARDS (33% versus 7.7%) and mortality (21% versus 4%) when early intramedullary femoral nailing was done. In the absence of severe chest trauma primary intramedullary femoral nailing is beneficial. In the presence of pulmonary injury primary intramedullary femoral nailing causes additional pulmonary damage and may trigger ARDS.