Femur fractures in chest-injured patients: Is reaming contraindicated?

Objective: To determine if reamed femoral intramedullary nailing increases the pulmonary complications seen in chest-injured patients. Design: Retrospective review of prospectively collected trauma database data from January 1991 to October 1994. Setting: Methodist Hospital, Indianapolis, Indiana, Level I Trauma Center. Patients: Group I: Chest-injured patients [chest Abbreviated Injury Score (AIS) greater than or equal to 2] without femur or tibia fractures. Group II: Chest-injured patients (chest AIS greater than or equal to 2) with femoral reamed intramedullary fixation. Group III: Chest-injured patients (chest AIS greater than or equal to 2) with femoral shaft fixation using nonreamed fixation (rush rods, plating, or external fixation). Group IV: Non-chest-injured patients (chest AIS < 2) with femoral reamed intramedullary fixation, Main Outcome Measurement/Hypothesis: Reamed femoral intramedullary nailing does not alter pulmonary outcomes, even in chest-injured patients. Results: Groups I and II had a very similar incidence of adult respiratory distress syndrome (ARDS), pneumonia, and number of ventilator days. Group III had a significantly higher incidence of ARDS and number of ventilator days than did Group I or II. Group III did not have a chest AIS score significantly different than Groups I and II. Group II had significantly higher ARDS and more ventilator days than did Group IV when only analyzing raw data. When injury severity was adjusted, there were no significant differences in pulmonary outcomes. Conclusion: Reamed intramedullary femoral fixation did not increase pulmonary morbidity in chest-injured patients.