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Multicenter Study
. 2021 Sep 1;35(9):499-504.
doi: 10.1097/BOT.0000000000002055.

Single-Stage Versus 2-Stage Bilateral Intramedullary Nail Fixation in Patients With Bilateral Femur Fractures: A Multicenter Retrospective Review

Ilexa R Flagstad  1   2 , Lauren M Tatman  1   3 , Austin Heare  1   2   4 , Harsh R Parikh  1   2 , Melissa Albersheim  1   2 , Jared Atchison  5 , Mary Breslin  6 , Patrick Davis  7 , Shawn Feinstein  8 , David J Hak  9 , Joseph T Labrum 4th  3 , Reuben C Lufrano  10 , Erik A Lund  7 , Daniel Connelly  5 , Robert N Matar  11 , Jason Nadeau  9 , Danielle Ries de Chaffin  12 , Andres F Rodriguez-Buitrago  3 , Tegan Schmidt  6 , Nichole Shaw  5 , Natasha Simske  6 , Alexander B Siy  10 , Julie Titter  8 , Sandy Vang  1   2 , Emily Wagstrom  12 , Jerald R Westberg  12 , Jesse Hahn  8 , Cyril Mauffrey  9 , Hassan R Mir  7 , Robert V O'Toole  5 , William T Obremskey  3 , Roy W Sanders  7 , Andrew H Schmidt  12 , Heather A Vallier  9 , Paul S Whiting  10 , Brian P Cunningham  1   13   14
Affiliations
Multicenter Study

Single-Stage Versus 2-Stage Bilateral Intramedullary Nail Fixation in Patients With Bilateral Femur Fractures: A Multicenter Retrospective Review

Ilexa R Flagstad et al. J Orthop Trauma. .

Abstract

Objective: To evaluate rates of complications in patients with bilateral femur fractures treated with intramedullary nailing (IMN) during either 1 single procedure or 2 separate procedures.

Design: A multicenter retrospective review of patients sustaining bilateral femur fractures, treated with IMN in single or 2-stage procedure, from 1998 to 2018 was performed at 10 Level-1 trauma centers.

Setting: Ten Level-1 trauma centers.

Patients/participants: Two hundred forty-six patients with bilateral femur fractures.

Interventions: Intramedullary nailing.

Main outcome measures: Incidence of complications.

Results: A total of 246 patients were included, with 188 single-stage and 58 two-stage patients. Gender, age, injury severity score, abbreviated injury score, secondary injuries, Glasgow coma scale, and proportion of open fractures were similar between both groups. Acute respiratory distress syndrome (ARDS) occurred at higher rates in the 2-stage group (13.8% vs. 5.9%; P value = 0.05). When further adjusted for age, gender, injury severity score, abbreviated injury score, Glasgow coma scale, and admission lactate, the single-stage group had a 78% reduced risk for ARDS. In-hospital mortality was higher in the single-stage cohort (2.7% compared with 0%), although this did not meet statistical significance (P = 0.22).

Conclusions: This is the largest multicenter study to date evaluating the outcomes between single- and 2-stage IMN fixation for bilateral femoral shaft fractures. Single-stage bilateral femur IMN may decrease rates of ARDS in polytrauma patients who are able to undergo simultaneous definitive fixation. However, a future prospective study with standardized protocols in place will be required to discern whether single- versus 2-stage fixation has an effect on mortality and to identify those individuals at risk.

Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Conflict of interest statement

The authors report no conflict of interest.

References

    1. Wu CC, Shih CH. Simultaneous bilateral femoral shaft fractures. J Trauma. 1992;32:289–293.
    1. Beam HP, Seligson D. Nine cases of bilateral femoral shaft fractures: a composite view. J Trauma. 1980;20:399–402.
    1. Nork SE, Agel J, Russel GV, et al. Mortality after reamed intramedullary nailing of bilateral femur fractures. Clin Orthop Relat Res. 2003;415:272–278.
    1. Copeland CE, Mitchell KA, Brumback RJ, et al. Morality in patients with bilateral femoral fractures. J Orthop Trauma. 1998;12:315–319.
    1. Giannoudis PV, Cohen A, Hinsche A, et al. Simultaneous bilateral femoral fractures: systemic complications in 14 cases. Int Orthop. 2000;24:264–267.

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