Retrograde intramedullary nailing of femoral diaphyseal fractures caused by low-velocity gunshots.

The purpose of this study was to evaluate the results of retrograde intramedullary nailing of femoral diaphyseal fractures caused by low-velocity gunshots. Seventy-three patients (68 men and 5 women) with 74 femoral diaphyseal fractures caused by gunshots were treated with reamed, retrograde, statically locked intramedullary nailing. The main outcome measures were fracture union, the need for additional operations, shortening, angular deformity, postoperative knee range of motion, and complication rate. Twenty-nine patients sustained additional injuries. During initial treatment, 18 patients underwent further orthopedic and nonorthopedic elective procedures. Three patients had fasciotomies for compartment syndrome. At follow-up, 3 patients had shortening >10 mm (range, 12-18 mm) and 1 had angulation >10 degrees (13 degrees recurvatum). Four patients underwent surgeries after discharge. Complications included 1 case of heterotopic bone formation, 1 hypertrophic nonunion that went on to union after dynamization, 2 postoperative positive blood cultures, and 1 wound dehiscence. There were no cases of septic arthritis. Our data indicate that there is a low incidence of shortening, angular deformity, complication, and infection rates following treatment of femoral gunshot diaphyseal fractures with a retrograde nail. This study demonstrates that this is an acceptable alternative for the treatment of these injuries.

Factors affecting length of stay after isolated femoral shaft fractures.

BACKGROUND: Controlling escalating health care costs is important for hospitals and has far reaching implications for society. Hospital length of stay (LOS) is one of the most reliable predictors of cost after trauma. Our purpose was to establish LOS after isolated femur fractures treated by intramedullary (IM) nail. METHODS: The trauma registry was queried to identify patients. Patients were excluded if they required assistive ambulatory devices before injury, had chronic/terminal illness or compromised brain function. There were 102 patients with an average age of 27 years. Statistical analysis was completed. RESULTS: The average LOS was 3.9 days. In all, 27 patients stayed longer than 4 days. Reasons included social (7), medical (10), and hospital delays (10). The average time from arrival to surgery was 17 hours. The average time from surgery to physical therapy was 1.3 days. Patients who had surgery more than 24 hours after arrival stayed longer. Patients requiring placement stayed 2.4 days longer until placement was found. CONCLUSIONS: Factors the hospital can control to reduce LOS include time to surgery, time for physical therapy evaluation, and radiology delays (for spine clearance radiographs). Physical therapy availability within 24 hours of surgery is important and should include weekends and holidays. Early evaluation of social factors including homelessness or obstacles to independent living may reduce time to find placement. LOS reduction after femur fractures will decrease the cost of trauma to the hospital. In addition, LOS reduction will possibly increase bed availability and minimize the time spent on diversion yielding greater revenues and increasing patient satisfaction.