Femoral shaft fracture fixation and chest injury after polytrauma.

摘要

Thirty years ago, the standard of care for the multiply injured patient with fractures was placement of the fractured limb in a splint or skeletal traction, until the patient was considered stable enough to undergo surgery for fracture fixation1. This led to a number of complications2,. such as adult respiratory distress syndrome (ARDS), infection, pneumonia, malunion, non-' union, and death, particularly when the patient had a high Injury Severity Score (ISS)3. Retrospective studies showed that the incidence of fat embolism syndrome could be reduced with stabilization of long-bone fractures in a multiply injured patient. Riska et al. noted a decrease in fat embolism syndrome from 22% (twenty-one of ninety-five) with traction treatment to 1% (one of ninety-five) with early operative fracture stabilization4. This finding led to greater use of early surgical stabilization of femoral fractures in the multiply injured patient. Subsequent follow-up studies demonstrated decreases in mortality and morbidity with early surgical stabilization of long-bone fractures in the multiply injured patient.