A Comparison of the Prevalence of, Demographics of, and Effects on Outcomes of Bilateral Versus Unilateral Femoral Shaft Fractures: A Retrospective Cohort Analysis From the National Trauma Data Bank.

Objectives: To document the prevalence of, and the effect on outcomes, operatively treated bilateral femur fractures treated using contemporary treatments.
Design: A retrospective cohort using data from the National Trauma Data Bank.
Participants: In total, 119,213 patients in the National Trauma Data Bank between the years 2007 and 2015 who had operatively treated femoral shaft fractures.
Main Outcome Measurements: Complication rates, hospital length of stay (LOS), days in the intensive care unit (ICU LOS), days on a ventilator, and mortality rates.
Results: Patients with bilateral femur fractures had increased overall complications (0.74 vs. 0.50, P < 0.0001), a longer LOS (14.3 vs. 9.2, P < 0.0001), an increased ICU LOS (5.3 vs. 2.4, P < 0.0001), and more days on a ventilator (3.1 vs. 1.3, P < 0.0001), when compared with unilateral fractures. Bilateral femoral shaft fractures were independently associated with worse outcomes in all primary domains when adjusted by Injury Severity Score (P < 0.0001), apart from mortality rates. Age-adjusted bilateral injuries were independently associated with worse outcomes in all primary domains (P < 0.0001) except for the overall complication rate. A delay in fracture fixation beyond 24 hours was associated with increased mortality (P < 0.0001) and worse outcomes for all other primary measures (P < 0.0001 to P = 0.0278) for all patients.
Conclusions: Bilateral femoral shaft fractures are an independent marker for increased hospital and ICU LOS, number of days on a ventilator, and increased complication rates, when compared with unilateral injuries and adjusted for age and Injury Severity Score. Timely definitive fixation, in a physiologically appropriate patient, is critical because a delay is associated with worse inpatient outcome measures and higher mortality rates.
Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Competing Interests: C. T. Cosgrove and M. B. Berkes report no conflict of interest. D. L. Stwalley: AbbVie, Bristol-Myers Squibb: stock or stock options in a company or supplier. A. N. Miller: AONA, Smith & Nephew, Stryker: Other financial or material support. American College of Surgeons, Association for the Advancement of Automotive Medicine, Orthopaedic Trauma Association: Board or committee member. Bone support: Research support. Journal of Bone and Joint Surgery Am, Journal of Orthopaedic Trauma: Editorial or governing board. C. M. McAndrew: Zimmer: Paid consultant. P. R. Wolinsky: AAOS, American College of Surgeons, California Orthopaedic Association, Orthopaedic Trauma Association: Board or committee member Journal of Orthopaedic Trauma: Editorial or governing board, Zimmer: Paid presenter or speaker.
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