Severity of injuries associated with femoral fractures as a result of motor vehicle collisions

Femoral fractures are an indicator of increased severity of injury for road traffic collision victims: an autopsy-based case-control study on 4895 fatalities

INTRODUCTION

The course of road traffic collision (RTC) victims with femoral fractures (FFx) from injury to death was reviewed. We sought to correlate the presence of femoral fractures with the overall severity of injury from RTCs using objective indices and to identify statistically significant associations with injuries in other organs.

PATIENTS AND METHODS

A case-control study based on forensic material from 4895 consecutive RTC-induced fatalities, between 1996 and 2005. Injuries were coded according to the Abbreviated Injury Scale-1990 Revision (AIS-90), and the Injury Severity Score (ISS) was calculated. Victims were divided according to the presence of femoral fractures in all possible anatomic locations or not. Univariate comparisons and logistic regression analysis for probabilities of association as odds ratios (OR) were performed.

RESULTS

The FFx group comprised 788 (16.1%) victims. The remaining 4107 victims constituted the controls. The FFx group demonstrated higher ISS (median 48 vs 36, p < 0.001) and shorter post-injury survival times (median 60 vs 85 min, p < 0.001). Presence of bilateral fractures (15.5%) potentiated this effect (median ISS 50 vs 43, p = 0.006; median survival time 40 vs 65, p = 0.0025; compared to unilateral fractures). Statistically significant associations of FFx were identified with AIS2-5 thoracic trauma (OR 1.43), AIS2-5 abdominal visceral injuries (OR 1.89), AIS1-3 skeletal injuries of the upper (OR 2.7) and lower limbs (OR 3.99) and AIS2-5 of the pelvis (OR 2.75) (p < 0.001). In the FFx group, 218 (27.7%) victims survived past the emergency department and 116 (53.2%) underwent at least one surgical procedure. Complications occurred in 45.4% of hospitalized victims, the most common being pneumonia (34.8%).

CONCLUSION

This study has documented that femoral fractures are associated with increased severity of injury, shorter survival times and higher incidence of associated thoracic, abdominal and skeletal extremity injuries, compared to controls. These findings should be considered for an evidence-based upgrading of trauma care.

Hip Pain After a Femoral Fracture: It Is Not Always Related to the Implant

The source of continued hip pain following fixation of traumatic femoral shaft fracture is not always clear. Intra-articular hip pathology is often overlooked when evaluating the etiology of residual pain. The purpose of this study was to describe cases of intra-articular hip pathology following traumatic femoral shaft fracture. This was a retrospective case series of patients presenting to a private practice orthopedic clinic from 2012 to 2015. Three patients presented with symptomatic intra-articular hip pathology following traumatic ipsilateral femoral shaft fracture. Patients who underwent hip arthroscopy with allograft labral reconstruction were identified retrospectively. Validated, subjective outcome scores administered included the Modified Harris Hip Score (MHHS), Lower Extremity Functional Scale (LEFS), visual analog scale (VAS) for pain, and VAS scale for patient satisfaction. Three patients were identified with residual, disabling groin pain after femoral shaft fracture fixation following a traumatic motor vehicle accident. All 3 patients were found to have a symptomatic ipsilateral labral tear. In 2 of the patients, an indentation on the lateral femoral head was appreciated, which was hypothesized to be caused by a subluxation event. All 3 patients were treated with arthroscopic hip surgery. At final follow-up, all 3 patients showed significant improvement in MHHS, VAS pain scores, level of satisfaction, and LEFS. Residual pain following ipsilateral femoral shaft fracture is not always related to implant. Intra-articular hip pathology should be considered in patients with lingering hip pain. [Orthopedics. 2016; 39(6):e1080-e1084.].