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Ghouri SI, Asim M, Mustafa F, Kanbar A, Ellabib M, Al Jogol H, Muneer M, Abdurraheim N, Goel AP, Abdelrahman H, Al-Thani H, El-Menyar A. Patterns, Management, and Outcome of Traumatic Femur Fracture: Exploring the Experience of the Only Level 1 Trauma Center in Qatar. Int J Environ Res Public Health 2021; 18:ijerph18115916. [PMID: 34072990 PMCID: PMC8198965 DOI: 10.3390/ijerph18115916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/24/2021] [Accepted: 05/27/2021] [Indexed: 11/16/2022]
Abstract
Background: Femur is the most fractured long bone in the body that often necessitates surgical fixation; however, data on the impact of the mechanism of injury (MOI), age, and timing of intervention are lacking in our region of the Arab Middle East. We aimed to describe the patterns, management, and outcome of traumatic femoral shaft fractures. Methods: A retrospective descriptive observational study was conducted for all trauma patients admitted with femoral shaft fractures between January 2012 and December 2015 at the only level 1 trauma center and tertiary hospital in the country. Data were analyzed and compared according to the time to intervention (intramedullary nailing; IMN), MOI, and age groups. Main outcomes included in-hospital complications and mortality. Results: A total of 605 hospitalized cases with femur fractures were reviewed. The mean age was 30.7 ± 16.2 years. The majority of fractures were unilateral (96.7%) and 91% were closed fractures. Three-fourths of fractures were treated by reamed intramedullary nailing (rIMN), antegrade in 80%. The pyriform fossa nails were used in 71.6% while trochanteric entry nails were used in 28.4%. Forty-five (8.9%) fractures were treated with an external fixator, 37 (6.1%) had conservative management. Traffic-related injuries occurred more in patients aged 14–30 years, whereas fall-related injuries were significantly higher in patients aged 31–59. Thirty-one patients (7.8%) had rIMN in less than 6 h post-injury, 106 (25.5%) had rIMN after 6–12 h and 267 (66.8%) had rIMN after more than 12 h. The implant type, duration of surgery, DVT prophylaxis, in-hospital complications, and mortality were comparable among the three treatment groups. Conclusions: In our center, the frequency of femoral fracture was 11%, and it mainly affected severely injured young males due to traffic-related collisions or falls. Further multicenter studies are needed to set a consensus for an appropriate management of femur fracture based on the MOI, location, and timing of injury.
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Affiliation(s)
- Syed Imran Ghouri
- Department of Surgery, Orthopedic Surgery, Hamad General Hospital, Doha, Qatar;
| | - Mohammad Asim
- Clinical Research, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar;
| | - Fuad Mustafa
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar; (F.M.); (A.K.); (M.E.); (H.A.J.); (N.A.); (A.P.G.); (H.A.)
| | - Ahad Kanbar
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar; (F.M.); (A.K.); (M.E.); (H.A.J.); (N.A.); (A.P.G.); (H.A.)
| | - Mohamed Ellabib
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar; (F.M.); (A.K.); (M.E.); (H.A.J.); (N.A.); (A.P.G.); (H.A.)
| | - Hisham Al Jogol
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar; (F.M.); (A.K.); (M.E.); (H.A.J.); (N.A.); (A.P.G.); (H.A.)
| | - Mohammed Muneer
- Department of Surgery, Plastic Surgery, Hamad General Hospital, Doha, Qatar;
| | - Nuri Abdurraheim
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar; (F.M.); (A.K.); (M.E.); (H.A.J.); (N.A.); (A.P.G.); (H.A.)
| | - Atirek Pratap Goel
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar; (F.M.); (A.K.); (M.E.); (H.A.J.); (N.A.); (A.P.G.); (H.A.)
| | - Husham Abdelrahman
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar; (F.M.); (A.K.); (M.E.); (H.A.J.); (N.A.); (A.P.G.); (H.A.)
| | - Hassan Al-Thani
- Department of Surgery, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar;
| | - Ayman El-Menyar
- Clinical Research, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar;
- Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
- Correspondence: ; Tel.: +974-44396130
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Alomary I, Tuma M, Abdurraheim N, Abdul Rahman H, Zarour A, Althani H, Latifi R. Critique of “Sew it Up! A Western Trauma Association Multi-Institutional Study of Enteric Injury Management in the Postinjury Open Abdomen”☆. Journal of Emergency Medicine, Trauma and Acute Care 2013. [DOI: 10.5339/jemtac.2013.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background: Use of damage control surgery techniques has reduced mortality in critically injured patients but at the cost of the open abdomen. With the option of delayed definitive management of enteric injuries, the question of intestinal repair/anastomosis or definitive stoma creation has been posed with no clear consensus. The purpose of this study was to determine outcomes on the basis of management of enteric injuries in patients relegated to the postinjury open abdomen. Methods: Patients requiring an open abdomen after trauma from January 1, 2002 to December 31, 2007 were reviewed. Type of bowel repair was categorized as immediate repair, immediate anastomosis, delayed anastomosis, stoma and a combination. Logistic regression was used to determine independent effect of risk factors on leak development. Results: During the 6-year study period, 204 patients suffered enteric injuries and were managed with an open abdomen. The majority was men (77%) sustaining blunt trauma (66%) with a mean age of 37.1 years ± 1.2 years and median Injury Severity Score of 27 (interquartile range = 20–41). Injury patterns included 81 (40%) small bowel, 37 (18%) colonic, and 86 (42%) combined injuries. Enteric injuries were managed with immediate repair (58), immediate anastomosis (15), delayed anastomosis (96), stoma (10), and a combination (22); three patients died before definitive repair. Sixty-one patients suffered intra-abdominal complications: 35 (17%) abscesses, 15 (7%) leaks, and 11 (5%) enterocutaneous fistulas. The majority of patients with leaks had a delayed anastomosis; one patient had a right colon repair. Leak rate increased as one progresses toward the left colon (small bowel anastomoses, 3% leak rate; right colon, 3%; transverse colon, 20%; left colon, 45%). There were no differences in emergency department physiology, injury severity, transfusions, crystalloids, or demographic characteristics between patients with and without leak. Leak cases had higher 12-hour heart rate (148 vs. 125, p = 0.02) and higher 12-hour base deficit (13.7 vs. 9.7, p = 0.04), suggesting persistent shock and consequent hypoperfusion were related to leak development. There was a significant trend toward higher incidence of leak with closure day (χ for trend, p = 0.01), with closure after day 5 having a four times higher likelihood of developing leak (3% vs. 12%, p = 0.02). Conclusions: Repair or anastomosis of intestinal injuries should be considered in all patients. However, leak rate increases with fascial closure beyond day 5 and with left-sided colonic anastomoses. Investigating the physiologic basis for intestinal vulnerability of the left colon and in the open abdomen is warranted.
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Affiliation(s)
- Ismail Alomary
- Trauma Surgery Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Mazin Tuma
- Trauma Surgery Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Nuri Abdurraheim
- Trauma Surgery Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Husham Abdul Rahman
- Trauma Surgery Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Zarour
- Trauma Surgery Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Hassan Althani
- Trauma Surgery Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Rifat Latifi
- Trauma Surgery Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
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