Reassessing the role of external fixation in polytrauma and severly injured patients with chest trauma and femur fracture: a propensity score-matched analysis from the TraumaRegister DGU®
Year: 2025
Type: article
Study design: Observational Study
Abstract: INTRODUCTION: Early intramedullary nailing for femur fractures in patients with thoracic trauma has been controversial due to concerns about exacerbating pulmonary complications, particularly in cases of lung contusion. Older studies, relying on conventional radiographs that detected only severe contusions, recommended damage control surgery with external fixation. Today, high-resolution computed tomography (CT) detects even mild lung contusions, potentially overestimating lung damage. Coupled with modern ventilation strategies, this has prompted a reassessment of early definitive fixation versus external fixation in these patients. METHODS: between 2019 and 2023. A propensity score-matched analysis (n = 2,014) was conducted to compare patients treated with intramedullary nailing (IMN) and external fixation. Clinical endpoints included mortality, Intensive Care Unit (ICU) and hospital length of stay, multiple organ failure, and blood transfusion rates. RESULTS: Approximately half of the patients (46.8%) received initial external fixation of the femur fracture. External fixation was associated with higher injury severity score (ISS 31.5 vs. 26.1; p < 0.001) and were more frequently treated in Level-1 trauma centers and during night shifts. A propensity score matched analysis revealed no significant differences in mortality (6.0% early definitive care vs. 7.4% external fixation; p = 0.212) or multiple organ failure rates (25.3% vs. 29.4%; p = 0.091). However, external fixation patients had longer ICU stays (median 10 vs. 7 days; p < 0.001) and hospital stays (median 25 vs. 20 days; p < 0.001). CONCLUSION: These findings suggest that external fixation of femur fractures may not be universally necessary, particularly in patients with moderate chest trauma, and early definitive care may offer comparable outcomes with shorter recovery times. Standardized criteria are needed to optimize treatment decisions and reserve external fixation for cases where it is clinically essential.
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $2,490
OpenAlex ID: W4414436833