Timing of diaphyseal femur fracture nailing: Is the difference night and day?

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• 作者：Neeraj M. Patel ; Richard S. Yoon ; John D. Koerner ; Derek J. Donegan ; Frank A. Liporace
• 关键词：Femoral shaft fracture ; Intramedullary nail ; Femoral version ; Femoral length ; Limb length discrepancy ; Time of day
• 刊名：Injury
• 出版年：March, 2014
• 年：2014
• 卷：45
• 期：3
• 页码：546-549
• 全文大小：248 K

文摘

Introduction

Most hospitals are faced with reduced personnel, resources, and provider fatigue or shift changes when day turns to night. For these reasons, some have suggested that diaphyseal femur fractures should be fixed during the daytime. The purpose of this study is to determine whether the time of surgery affects the post-operative difference in femoral version (DFV) and femoral length (DFL) between the fixed and uninjured sides following intramedullary nailing (IMN).

Materials and methods

Over a 10-year period, 340 patients underwent IMN of a diaphyseal femur fracture (AO types 32-A to C) with a post-operative computed tomography scanogram for version measurement. Demographic and surgical data, including time operated was collected. 鈥淒aytime鈥?was defined as 7:00 AM to 6:59 PM, while the remainder of the clock was 鈥渘ighttime鈥? Additionally, the night hours were split into 3 consecutive 4-h categories for further analysis. Stepwise, multivariate regressions were used to evaluate any effect of time of surgery on post-operative DFV or DFL. Other variables included in these statistical models were age, sex, mechanism of injury, open vs. closed fracture, trauma vs. non-trauma surgeon, and AO and Winquist classifications.

Results

Overall, 22.4% (76/340) of all fractures were fixed at night. The mean post-operative DFV and DFL from the uninjured side in these patients was 8.9掳 and 4.1 mm, respectively, compared to 9.0掳 and 4.8 mm in those treated during the daytime. This difference was not statistically significant when accounting for other factors (m>pm> > 0.05). There was no statistically significant difference in patients with >10 mm limb length discrepancy or >15 degrees DFV (m>pm> = 1.0 for both).

Conclusion

The time of day at which diaphyseal femur fractures are treated does not have an impact on post-operative femoral version or length. While certain other injuries may be better handled during daytime hours, acceptable IMN of mid-shaft femur fractures may be achieved during all hours at a level 1 trauma centre.