Single-Stage versus Two-Stage Bilateral Intramedullary Nail Fixation in Patients with Bilateral Femur Fractures, A Multicenter Retrospective Review.

Abstract

OBJECTIVE\nTo evaluate rates of complications in patients with bilateral femur fractures treated with intramedullary nailing (IMN) during either one single procedure or two separate procedures.\n\n\nDESIGN\nA multicenter retrospective review of patients sustaining bilateral femur fractures, treat with IMN in single or two-stage procedure, from 1998-2018 was performed at ten level-1 trauma centers.\n\n\nSETTING\nTen level-1 trauma centers.Patients/Participants: 246 patients with bilateral femur fractures.\n\n\nINTERVENTIONS\nIntramedullary nailing.\n\n\nMAIN OUTCOME MEASUREMENTS\nIncidence of complications.\n\n\nRESULTS\nA total of 246 patients were included, with 188 single-stage and 58 two-stage patients. Gender, age, ISS, AIS, secondary injuries, GCS, and proportion of open fractures were similar between both groups. Acute respiratory distress syndrome (ARDS) occurred at higher rates in the two-stage group (13.8% versus 5.9%, p-value = 0.05). When further adjusted for age, gender, ISS, AIS, GCS, 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 to 0%), although this did not meet statistical significance (p=0.22).\n\n\nCONCLUSIONS\nThis is the largest multicenter study to date evaluating the outcomes between single- and two- 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 two-stage fixation has an effect on mortality and to identify those individuals at risk.\n\n\nLEVEL OF EVIDENCE\nDiagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.