Division of Surgery, Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, New South Wales, Australia.
J Trauma Acute Care Surg. 2013 Jun;74(6):1516-20. doi: 10.1097/TA.0b013e31828c3dc9.
The management of patients with femoral shaft fractures (FSFs) is often a decision making dilemma (damage-control orthopedics vs. early total care), with equivocal evidence. The comprehensive, population-based epidemiology of patients with FSF is unknown. The purpose of this prospective study was to describe the epidemiology of patients with FSF, with special focus on patient physiology and timing of surgery.
A 12-month prospective population-based study was performed on consecutive patients with FSF in an area with 850,000 population including all ages and prehospital deaths. Patient demographics, mechanism, Injury Severity Score (ISS), shock parameters (systolic blood pressure, base deficit and lactate), transfusion requirement, fracture type [Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association classification (OA/OTA)], comorbidities, procedures, and outcomes were recorded. Patients hemodynamic status was described as stable, borderline, unstable, and "in extremis."
A total of 126 patients (21 per 100,000 per year) with 136 femur fractures (62% male; age, 38 [28] years; ISS, 20 [19]; 51% multiple injuries) were identified in the region. Sixty patients (48.4%) sustained a high-energy injury with 19 (31.1%) of these being polytrauma patients (ISS, 28 [12]; systolic blood pressure, 98 [39]; base deficit, 6.5 [5.8]; lactate 4 [2]).Fifteen polytrauma patients (94%) required massive transfusion (12 [12] U of packed red blood cells, 8 [5] fresh frozen plasma, 1 [0.4] platelet, 13 [8] cryoprecipitate). Twenty-one patients (16.7%) died at the prehospital setting (3.5 per 100,000 per year). From the 105 hospital admissions, 68.3% was stable (14.3 per 100,000 per year), 8.7% was borderline (1.8 per 100,000 per year), 4.0% was unstable (0.8 per 100,000 per year) and 2.4% (0.5 per 100,000 per year) was in extremis. Six patients (5.7%) died. The length of stay (LOS) was 18 (15) days, and the intensive care unit LOS was 5 (6) days. Fourty-five patients sustained a low-energy injury that had in 85% of cases multiple comorbidities. Eight low-energy patients needed 3 (1) transfusions, and none of the patients died. The LOS was 15 (11) days.
Patients with low-energy FSF have a hospital admission rate similar to the patients with high-energy FSF. Sixty-eight percent of patients with FSF are complicated (open, compromised physiology, multiple injuries, bilateral, elderly with comorbidities, etc.), requiring major resources and highly specialized care.
Epidemiology study, level III.
股骨骨干骨折（FSF）的治疗管理常常是一个决策难题（损伤控制骨科与早期全面治疗），证据存在争议。FSF 患者的综合、基于人群的流行病学情况尚不清楚。本前瞻性研究的目的是描述 FSF 患者的流行病学情况，特别关注患者的生理状况和手术时机。
在一个拥有 85 万人口的地区，进行了一项为期 12 个月的连续 FSF 患者前瞻性基于人群的研究，包括所有年龄组和院前死亡患者。记录患者的人口统计学资料、发病机制、损伤严重度评分（ISS）、休克参数（收缩压、基础缺失和乳酸）、输血需求、骨折类型[骨折协会/骨科创伤协会分类（OA/OTA）]、合并症、手术程序和结果。患者的血流动力学状态描述为稳定、临界、不稳定和“病危”。
该地区共发现 126 例（每年每 10 万人 21 例）136 例股骨骨折（62%为男性；年龄 38[28]岁；ISS 20[19]；51%为多发伤）。60 例（48.4%）为高能损伤，其中 19 例（31.1%）为多发伤患者（ISS 28[12]；收缩压 98[39]；基础缺失 6.5[5.8]；乳酸 4[2]）。15 例多发伤患者（94%）需要大量输血（12[12]单位浓缩红细胞、8[5]新鲜冷冻血浆、1[0.4]血小板、13[8]冷沉淀）。21 例（3.5%/每年每 10 万人）在院前死亡。在 105 例住院患者中，68.3%（每年每 10 万人 14.3 例）为稳定型，8.7%（每年每 10 万人 1.8 例）为临界型，4.0%（每年每 10 万人 0.8 例）为不稳定型，2.4%（每年每 10 万人 0.5 例）为病危型。6 例（5.7%）患者死亡。住院时间（LOS）为 18（15）天，重症监护病房 LOS 为 5（6）天。45 例为低能损伤，其中 85%有多种合并症。8 例低能损伤患者需要 3（1）次输血，无患者死亡。LOS 为 15（11）天。
低能 FSF 患者的住院率与高能 FSF 患者相似。68%的 FSF 患者存在并发症（开放性、生理状况受损、多发伤、双侧、合并症的老年患者等），需要大量资源和高度专业化的护理。
流行病学研究，III 级。
