Incidence, management, and outcome of femoral shaft fracture: a statewide population-based analysis of 2805 adult patients in a rural state.

UNLABELLED: Early surgical management of femoral shaft fracture (FSF) is considered the standard but patients are still treated nonsurgically. The purpose of this study was to analyze the results of management of FSF in a large population based data base.

METHODS: Data were obtained from a statewide hospital discharge data base for 1989-1992. Adults having a FSF were stratified by ISS (ISS < 15 vs. ISS > or = 15) and management (nonsurgical, surgery within 1 day, surgery at 2-4 days, or surgery at > 4 days). Mortality rates and mean length of hospital stay were compared among groups.

RESULTS: 2805 patients had FSFs: 69% were managed surgically and 31% nonsurgically. Mortality was higher for nonsurgical therapy in both ISS groups. In the surgically treated groups, length of hospitalization increased as delay to surgery increased. In patients with an ISS > or = 15, repair at 2-4 days was associated with the lowest mortality and shortest hospitalization, while a trend to higher mortality and longer hospitalization was noted with repair within 1 day.

CONCLUSION: 31% of patients were treated nonsurgically with higher associated mortality. These results support "early" surgical fixation, which can shorten hospital stay without increasing mortality regardless of overall injury severity. The trend toward higher mortality in severely injured patients operated on within 1 day of admission suggests that this group warrants further study and individualized management.