Abstract
Introduction
The aim of this study was to investigate the differences between open vs closed femoral fractures with regard to the epidemiology, classification and outcome.
Patients & methods
Data collected prospectively from MTOS and TARN-UK. Between 2001 and 2005, 67,665 trauma patients found and 8,591 were identified having sustained femoral shaft fractures. Demographics, pre and in-hospital data were recorded. The AIS and ISS were calculated. Outcomes and mortality rates were recorded. Four groups of patients were identified namely isolated/open (IO), polytrauma/open (PO), isolated /closed (IC), polytrauma/closed (PC). ANOVA analysis was contacted to determine the effect of fracture classification and severity of trauma to mortality using SPSS 11.0 software.
Results
7,978 patients having full data were included. There were 6,780 (85%) Isolated and 1,198 (15%) Polytrauma femoral fractures. When looking at Open vs Closed fractures we found 786 (9.8%) and 7,192 (90.2%) respectively. Combining the groups we recorded 502 IO, 6,278 IC, 284 PO, 914 PC. The median age was 53.9 years, the male/female ratio was 1.15 and the median ISS was 9. Males predominantly presented with open fractures with age distribution prevalence between 16-44 years. Elderly females >74 presented prevalence in IC fractures. Polytrauma related fractures had over six times higher mortality rates than isolated ones. A trimodal distribution of death was confirmed. The incidence of immediate deaths (<1h) was 23.3% for PO vs the 17% of PC fractures. Isolated closed fatalities were in 55.7% late deaths (>1st week), mostly attributed to hospitalisation and late post-injury complications.
Conclusions
Young males predominate in this musculoskeletal entity. Elderly females present prevalence of closed fractures vs elderly males possibly due to osteoporosis. Open femoral fractures have a higher mortality rate as they represent high energy absorption. The combination of multiple trauma and femoral fractures shows higher mortality rates at all age groups.
