Predictors and Complications of Delayed Femoral Shaft Fracture Fixation in Pediatric Patients.

BACKGROUND

There is currently no consensus regarding optimal treatment of femoral shaft fractures in the pediatric population, particularly regarding timing of surgical fixation. This large, retrospective database study seeks to identify predictors of delayed fixation of femoral shaft fractures in pediatric patients, and whether delayed fixation may be associated with certain complications.

METHODS

Data were drawn from the American College of Surgeons Trauma Quality Improvement Program (TQIP) database. Pediatric patients with femoral shaft fractures were stratified based on the timing of surgical fixation: <24 h or ≥24 h from ED presentation. The association of surgical timing with demographics, injury characteristics, and complications was assessed by univariate analysis and a multivariate regression model.

RESULTS

Patients with ISS scores >15 ( < .01), worse GCS scores ( < .01), older age (10-16 years, = .02), and higher number of days on ventilator ( < .01) were more likely to have delayed fixation. The delayed fixation cohort showed significantly higher rates of complications, including DVT, PE, and pressure ulcer injury ( < .03). Patients who underwent delayed fixation were also more likely to have a complication ( < .01), and those with a more severe ISS (>15) and who spent longer days on a ventilator were more likely to have a complication ( < .01).

CONCLUSIONS

Our study demonstrates significant predictors of delayed fixation, in addition to showing a significant association with higher rates of complications. To our knowledge, this is the first study to use a large clinical database to assess predictors of femoral fracture timing and associated complications in the pediatric population.

KEY CONCEPTS

(1)Optimal timing of surgical fixation of pediatric femoral shaft fractures has yet to be established.(2)This large, retrospective database study identifies significant predictors of delayed fixation: patients with ISS scores >15, worse GCS scores, older age, and higher number of days on a ventilator.(3)The median time to fixation was 33.85 h, and delayed fixation (≥24 h) was significantly associated with the development of various complications.

LEVEL OF EVIDENCE

III.