Injury-International Journal of the Care of the Injured最新文献

{"title":"Indications and clinical results of Non-Operative management of periprosthetic hip fractures in elderly patients","authors":"Ricardo Fernández-Fernández,&nbsp;Jorge Fuentes-Sánchez,&nbsp;Javier Gómez-Luque,&nbsp;Ana Cruz-Pardos","doi":"10.1016/j.injury.2024.111738","DOIUrl":"10.1016/j.injury.2024.111738","url":null,"abstract":"<div><h3>Background</h3><div>The increase in life expectancy in the general population has led to a rise in the use of hip arthroplasties and consequently, to an increase in the incidence of periprosthetic hip fractures (PPHF). The impact of this type of fracture on patients necessitates a personalized approach to treatment, whether surgical or non-operative, taking into account the trajectory and associated comorbidities.</div></div><div><h3>Methods</h3><div>We performed a retrospective study of 80 patients over the age of 70 diagnosed with a periprosthetic hip fracture between 2011 and 2018. These cases were reviewed after a minimum follow-up of 5 years. We included demographic data, comorbidities including Charlson comorbidity index (CCI), primary prosthesis characteristics, fracture type according to the Vancouver classification, treatment received and mortality among others. Radiographs were analyzed during follow-up and Merle D'Aubigné and visual analog scales were performed.</div></div><div><h3>Results</h3><div>Fifty-two of the 80 fractures analyzed involved total hip arthroplasties, 26 were hemiartroplasties and only 2 were revision prostheses. A total of 77.5 % had cementless stems and 88.8 % of the patients had significant comorbidities. There were 29 B1 (36.3 %) and 30 B2 (37.5 %) fractures which compromised most of the study cohort. Fifty-three patients underwent surgery compared to 27 patients (34 %) treated non-operatively; most of the latter had short, oblique undisplaced B1 fractures. 28 fractures (35 %) required reduction and fixation (ORIF) while 25 patients (31.3 %) underwent a revision arthroplasty (RA). The mean score at 3 months for the VAS scale was 2.9 points and for Merle D'Aubigné scale, the scores were 4.3 points for pain, 4.1 for mobility and 3.8 for ambulation. Seven patients who underwent surgery died in the first 2 months compared to 2 in the non-operative group. Revision arthroplasty had the highest prevalence of mortality (p=0.032) as did those with a CCI ≥ 6 (p=0.038).</div></div><div><h3>Conclusions</h3><div>In some low functional demand elderly patients with significant comorbidities non-operative treatment can be considered, especially in fractures with short transverse and oblique patterns where it provides similar clinical and radiographic results to surgical treatment whilst avoiding additional risks in these fragile and vulnerable patients.</div></div><div><h3>Level of Evidence</h3><div>Therapeutic Level IV (Case Series)</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 ","pages":"Article 111738"},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“Implant-associated infection after hip fracture surgery in elderly patients: Risk factors and mortality”","authors":"Cristina Ojeda-Thies ,&nbsp;Ana Rojo-Carpintero ,&nbsp;Francisco Soria-Perdomo ,&nbsp;Luis Rafael Ramos-Pascua","doi":"10.1016/j.injury.2024.111756","DOIUrl":"10.1016/j.injury.2024.111756","url":null,"abstract":"<div><h3>Aims</h3><div>Our study aimed to evaluate the prognosis of implant-related infection following hip fracture and pre-surgical, surgical and microbiological factors modifying outcomes.</div></div><div><h3>Methods</h3><div>We retrospectively included patients aged 65 and older treated for infection following surgically managed hip fractures between 2012 and 2022. Periprosthetic and high-energy fractures were excluded. Data was obtained by clinical chart review, including: age, gender, Barthel index, Charlson Score, National Hip Fracture Database (NHFD) Mobility Score, surgery and infection type, causative pathogens, antimicrobial resistance, anti-biofilm antibiotic treatment and clinical situation at one-year follow up. The outcomes evaluated were failure/resolution of infection and one-year mortality.</div></div><div><h3>Results</h3><div>We included 80 patients (67 women, 83.8 %) aged a median of 85 years (interquartile range: 78 – 88 years). Treatment failed in 38 (47.5 %) patients, and the one-year mortality was 37.5 %. Patients dying within 12 months after treatment were more likely to suffer acute vs. chronic infections (OR = 3.29 [95 %CI: 1.20–9.04]), be older and have more comorbidity, but baseline function and ambulation were not predictive. Treatment failure was higher among patients receiving non-antibiofilm controlling surgery, specifically surgical lavage (OR = 3.79 [95 %CI: 1.38–10,37]), as well as in older, more dependent patients. Receiving anti-biofilm antibiotics for more than 2 weeks was associated with less treatment failure (OR:0.32; [95 %CI: 0.13–0.80]) and 12-month mortality (OR:0.22 [95 %CI: 0.08–0.60]).</div></div><div><h3>Conclusions</h3><div>Antibiofilm-controlling surgery and antibiotics improve treatment success following implant-related infection after hip fracture and should be considered regardless of fracture type. Acute infections are a “second hit” for frail patients recovering from initial surgery and are associated with increased mortality.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 ","pages":"Article 111756"},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142712327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Managing B2 periprosthetic femoral fractures: ORIF vs stem-revision","authors":"S. Pombo-Alonso,&nbsp;I. Gabarain,&nbsp;N. Nunes,&nbsp;G. De la Herrán","doi":"10.1016/j.injury.2024.111789","DOIUrl":"10.1016/j.injury.2024.111789","url":null,"abstract":"<div><h3>Background</h3><div>The gold-standard treatment for Vancouver type B2 and B3 fractures is revision arthroplasty. This procedure can be prolonged and complex, posing challenges for patients with severe medical comorbidities and reduced physical status. Recently, osteosynthesis has been proposed as an alternative treatment for B2 periprosthetic femoral fractures (PFF) in frail patients, though its efficacy compared to revision arthroplasty has not been studied in detail.</div></div><div><h3>Methods</h3><div>A retrospective study was conducted from 2012 to 2022, comparing complications, mortality, length of stay, gait ability, hemoglobin decrease, and blood transfusion rates between 44 patients undergoing treatment for B2 or B3 PPF with either stem-revision arthroplasty (<em>n</em> = 28) or open reduction and internal fixation (ORIF) with plates and screws (<em>n</em> = 16).</div></div><div><h3>Results</h3><div>The results showed no significant differences in mortality, complications, hemoglobin decrease, blood transfusion rate, or length of stay between the two groups. In the stem-revision group, 11 patients (60.7 %) experienced a medical complication, while 7 patients (43.8 %) in the ORIF group had complications (<em>p</em> = 0.778). The mortality rate within the first year post-surgery was 17.9 % (5 patients) in the stem-revision group compared to 18.8 % (3 patients) in the ORIF group (<em>p</em> = 0.943). Surgical complications occurred in 2 patients (7.1 %) in the stem-revision group and in 4 patients (25 %) in the ORIF group (<em>p</em> = 0.101). Blood transfusions were required in 17 patients (60.7 %) in the stem-revision group and in 8 patients (50 %) in the ORIF group (<em>p</em> = 0.829).</div></div><div><h3>Conclusions</h3><div>This study suggests that ORIF is an acceptable treatment option for patients with B2 or B3 PFF, especially for those with severe medical comorbidities and reduced physical status who may not tolerate revision arthroplasty. However, further research with larger sample sizes and longer follow-up periods is needed to confirm these findings.</div></div><div><h3>Level of Evidence</h3><div>IV</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 ","pages":"Article 111789"},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142001542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The CLIPS Protocol: Cast re-aLignment In Paediatric patients using Stationery","authors":"Hiren Amirthalingam ,&nbsp;Bishoy Kirollos ,&nbsp;Harvinder Bedi ,&nbsp;Iswadi Damasena","doi":"10.1016/j.injury.2024.111932","DOIUrl":"10.1016/j.injury.2024.111932","url":null,"abstract":"<div><div>Paediatric tibial shaft fractures are commonly treated nonoperatively and followed-up in the clinic setting. Loss of position has traditionally been managed with wedging of the cast or admission and manipulation in the operaing theatre. The authors present a technique to aid in the wedging of plasters for paediatric tibia and forearm fractures that reduces time requirement, hospital costs and emotional distress on the part of the patient and family.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 12","pages":"Article 111932"},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142532278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“Fractures in the elderly in Spain: A call for enhanced quality of life and specialized care protocols”","authors":"Yaiza Lopiz","doi":"10.1016/j.injury.2024.111812","DOIUrl":"10.1016/j.injury.2024.111812","url":null,"abstract":"","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 ","pages":"Article 111812"},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142038088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proximal femoral fractures in the elderly. Does cement augmentation decrease mechanical failures and increase function? A retrospective cohort study","authors":"Héctor J Aguado ,&nbsp;Sergio País-Ortega ,&nbsp;Virginia García-Virto ,&nbsp;Patricia Bodas-Gallego ,&nbsp;Aranzazu Álvarez-Ramos ,&nbsp;Abel Ganso ,&nbsp;María Plata-García ,&nbsp;María Macho-Mier ,&nbsp;Ester Rodríguez-García ,&nbsp;Belén García-Medrano ,&nbsp;David C. Noriega","doi":"10.1016/j.injury.2024.111673","DOIUrl":"10.1016/j.injury.2024.111673","url":null,"abstract":"<div><h3>Introduction</h3><div>The management of extracapsular proximal femoral fractures (EPFF) with intramedullary nails in the elderly is hindered by osteoporosis, leading to complications that significantly impact functionality due to restrictions for full weight-bearing. We hypothesized that cement augmentation of the cephalic blade could enhance the bone-implant interface and reduce mechanical failure, thereby improving patient functionality in the management of EPFF.</div></div><div><h3>Materials and methods</h3><div>A retrospective cohort study was conducted on patients ≥ 70 years old with type 31-A EPFF (AO/OTA classification) treated with intramedullary nailing between 2017 and 2021, with and without cephalic blade augmentation with bone cement. Evaluation included demographic, clinical/functional parameters, complications, mortality, and radiological assessment (tip-apex distance (TAD), position of the helical blade, cut-out, cut-through, and any fixation failure).</div></div><div><h3>Results</h3><div>Fifty-eight patients were included, with 30 in the augmented group and 28 in the non-augmented group, with a median age of 88 and 86 years, respectively (<em>p</em> = 0.143), and a median follow-up of 17.9 and 18.2 months, respectively (<em>p</em> = 0.395). Both groups were comparable in terms of sex, Charlson Comorbidity Index, place of residence, pre-fracture mobility, and fracture stability. However, the non-augmented group showed worse ASA grade and pre-fracture cognitive status (<em>p</em> = 0.043). The most common position of the blade was center-center in both groups (96.7 % and 82.1 %, respectively) (<em>p</em> = 0.201). The mean TAD was 15.09 mm (±4.35) in the study group and 16.97 mm (±6.57) in the control group (<em>p</em> = 0.213). At one-year follow-up, there were no differences in medical complications (26.7 % and 28.6 %) (<em>p</em> = 1), surgical complications (6.7 % and 10.7 %) (<em>p</em> = 0.462), mortality (33.3 % and 21.4 %) (<em>p</em> = 0.385), or mechanical failure (0 % and 7.1 %) (<em>p</em> = 0.229). In the augmented group, one patient had intra-articular cement leak and implant infection, and a second patient presented avascular necrosis. In the non-augmented group, there was one periprosthetic fracture, one cut-out and one cut-through.</div></div><div><h3>Conclusions</h3><div>Cement augmentation in EPFF management does not improve functional outcomes or reduce mechanical complications. Furthermore, augmentation did not affect fracture reduction or the position of the helical blade in the head, nor was it associated with an increase in medical complications. However, augmentation can be considered a safe technique.</div></div><div><h3>Level of evidence</h3><div>Level IV.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 ","pages":"Article 111673"},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Classification of fracture-related infections: The FRI classification","authors":"Volker Alt","doi":"10.1016/j.injury.2024.111934","DOIUrl":"10.1016/j.injury.2024.111934","url":null,"abstract":"","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 11","pages":"Article 111934"},"PeriodicalIF":2.2,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early surgical care of the anticoagulated hip fracture patient within 24 hours","authors":"Carlos Pankratz,&nbsp;Raffael Cintean,&nbsp;Matti Hofmann,&nbsp;Dominik Boitin,&nbsp;Christoph Dehner,&nbsp;Florian Gebhard,&nbsp;Konrad Schuetze","doi":"10.1016/j.injury.2024.111924","DOIUrl":"10.1016/j.injury.2024.111924","url":null,"abstract":"<div><h3>Introduction</h3><div>Hip fractures are still associated with high morbidity and mortality. Despite international guidelines advocating for urgent surgical treatment, delays often occur, particularly for patients on long-term antithrombotic therapy. We hypothesised that urgent surgical care for the anticoagulated hip fracture patient is not associated with severe bleeding complications.</div></div><div><h3>Material and Methods</h3><div>For the period from 2015 to 2021, we retrospectively reviewed clinical records of 1142 patients with proximal femur fractures treated within 24 h of admission to our trauma centre (mean age 80.4 ± 12.4 years; 761 females, 381 males). The cohort comprised 409 femoral neck and 733 trochanteric fractures, managed with either arthroplasty (<em>n</em> = 297), hip-preserving techniques (<em>n</em> = 147), or intramedullary nailing (<em>n</em> = 698). Of these, 583 patients (51.1 %) were on long-term antithrombotic therapy. The primary endpoints included transfusion rate and the difference in haemoglobin (Hb) levels from pre- to postoperative. Secondary endpoints were in-patient mortality and occurrence of postoperative haematomas requiring surgical revision. A regression analysis was performed.</div></div><div><h3>Results</h3><div>The mean time to surgery was 10.3 h, with delays observed in patients on direct oral anticoagulants (DOACs). Overall, 25.9 % (<em>n</em> = 296) of the patients required blood transfusions. The transfusion rate was dependent on duration of the surgery, preoperative Hb level, and anticoagulation with DOACs. Similarly, the Hb difference was found to be dependent on the duration of surgery, preoperative Hb level, and anticoagulation with DOACs. In-patient mortality was 5.3 % (<em>n</em> = 60). Regression analysis indicated that mortality was dependent on a high ASA classification of 4 and the time to surgery, but not on the type of antithrombotic therapy. 3.1 % of the patients needed surgical revision due to postoperative haematoma with prolonged duration of surgery and antithrombotic therapy (PAI [OR = 3.7, 95 % CI: 1.1–12.7], DOACs [OR = 3.4, 95 % CI: 1.3–8.8], and VKA [OR = 5.5, 95 % CI: 1.8–17.1], <em>p</em> &lt; 0.05) as independent risk factors.</div></div><div><h3>Conclusion</h3><div>As postoperative haematoma and the need for transfusion are manageable situations, we conclude that immediate surgical treatment of hip fracture patients on long-term antithrombotic therapy within 24 h is feasible and patients may benefit.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 12","pages":"Article 111924"},"PeriodicalIF":2.2,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142432593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Injury surveillance in Spanish professional female soccer players: A three-season retrospective study","authors":"Ivan Medina-Porqueres ,&nbsp;Sara Sancho-Garcia ,&nbsp;Abel Gomez-Caceres ,&nbsp;Rafael Mondragon-Cortes ,&nbsp;Ana Madrid-Rodríguez ,&nbsp;Daniel Rosado-Velazquez","doi":"10.1016/j.injury.2024.111922","DOIUrl":"10.1016/j.injury.2024.111922","url":null,"abstract":"<div><h3>Introduction</h3><div>Despite the popularity of soccer at the male elite level, data on the incidence of injuries in female players are limited. The study aimed to evaluate the injury incidence and rates in female soccer players in a professional setting over 3 consecutive seasons.</div></div><div><h3>Methods</h3><div>Data compiled from 71 elite female players with different playing positions and belonging to the same team were analyzed. The location and severity of injuries were reported according to international consensus statements on the process of conducting epidemiological studies in professional soccer. The injury incidence rate (IIR) for matches and practices and the rate ratio (RR) were calculated, and time-loss injuries during the season were also recorded.</div></div><div><h3>Results</h3><div>A total of 53 injuries were documented, with an overall IIR of 1.08 injuries per 1000 h and an overall rate ratio of 0.61. The lower limbs were the most affected region (86,8 %). The majority of these injuries occurred around the thigh and knee and were predominantly traumatic, with markedly higher rates of injury during match play (2.78 injuries per 1000 h) when compared to injury incidence during training (0.79 injuries per 1000 h). Traumatic injuries accounted for 48 (91 %) and 24 (45,3 %) were indirect contact injuries. Reinjuries amounted to 15 % of total injuries and August was the predominant month for injury, being goalkeepers the least injured players (13.2 %).</div></div><div><h3>Conclusions</h3><div>Female professional soccer players displayed injury incidence rates and patterns comparable to those of male players. This study provides epidemiological information that will help to inform future injury surveillance studies and the development of prevention strategies to reduce the number of injuries in elite female soccer players, focusing specifically on thigh and knee regions. All match involvements should be considered when exploring associations between the type of exposure and injury risk.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 12","pages":"Article 111922"},"PeriodicalIF":2.2,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142432592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of surgical fixation timing on in-hospital mortality and morbidity of distal femur fractures","authors":"Joseph T Gutbrod ,&nbsp;Dustin Stwalley ,&nbsp;Anna N Miller","doi":"10.1016/j.injury.2024.111927","DOIUrl":"10.1016/j.injury.2024.111927","url":null,"abstract":"<div><h3>Introduction</h3><div>The literature lacks a large-scale study investigating the effect of surgical fixation timing on early mortality and morbidity outcomes in distal femur fractures. The aims of this study were to determine the effect of fixation timing on in-hospital mortality and morbidity outcomes for operatively treated distal femur fractures retrospectively using large database data.</div></div><div><h3>Methods</h3><div>This study is a retrospective analysis using data from the National Trauma Data Bank. Patients were stratified into a fragility cohort (age <span><math><mo>≥</mo></math></span> 60, ISS <span><math><mo>&lt;</mo></math></span> 16) and polytrauma cohort (age <span><math><mo>&lt;</mo></math></span> 60, ISS <span><math><mo>≥</mo></math></span>16), with both cohorts analyzed separately. Within each cohort, patients were split into three fixation timing groups: within 24 h, between 24 and 48 h, and greater than 48 h from presentation to the hospital. Fixation-timing groups were compared based on the primary outcome of in-hospital mortality rate. Secondary outcomes included hospital length of stay (LOS), ICU length of stay (ICU LOS), days on a ventilator, and complications.</div></div><div><h3>Results</h3><div>The fragility and polytrauma cohorts included 22,045 and 5,905 patients, respectively. The in-hospital mortality rate was 1.23 % in the fragility cohort and 2.56 % in the polytrauma cohort. Multivariate analysis of the fragility cohort showed that fixation greater than 48 h from time of presentation was associated with increased mortality compared to fixation within 24 h (OR 1.89, CI: 1.26–2.83, <strong><em>p</em></strong> <strong>=</strong> <strong>0.002</strong>) and between 24 and 48 h (OR 1.63, CI: 1.23–2.15, <strong><em>p</em></strong> <strong>&lt;</strong> <strong>0.001</strong>). In the polytrauma cohort, multivariate analysis showed no significant mortality differences between fixation timing groups. Multivariate analysis of morbidity outcomes in both cohorts showed that fixation greater than 48 h was associated with increased LOS, ICU LOS, ventilator days, and complications compared to fixation within 24 h. In the polytrauma cohort, fixation between 24 and 48 h was associated with decreased LOS, ICU LOS, and complications compared to the other two timing groups.</div></div><div><h3>Conclusions</h3><div>Fixation of distal femur fractures before 48 h from presentation may lead to improved mortality and morbidity in older, lower injury severity patients. No significant mortality benefit was observed in younger, polytrauma fractures. Further prospective work is needed to validate these findings.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 11","pages":"Article 111927"},"PeriodicalIF":2.2,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}