Date of Award

January 2019

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Jonathan N. Grauer

Abstract

Introduction:

Traumatic injuries, such as fractures, are known for having defined associated

injury patterns. These can alter management and affect outcome if not promptly

recognized and managed. There are limited large-scale studies of demographics,

mechanism of injury, and injuries associated with femoral and tibial shaft fractures.

Objectives:

1. To determine the demographics, mechanism of injury, injury severity score, and

associated injuries in those with femoral and tibial shaft fractures in a large

national sample.

2. To determine the relationship between associated injuries and in-hospital

mortality.

Methods:

In two separate studies, patients in the 2011 and 2012 National Trauma Data Bank

were analyzed for demographics, mechanism of injury, injury severity score, and

associated injuries. Using ICD-9 diagnosis codes, the first study examined patients with

tibial shaft fractures, while the second study examined patients with femoral shaft

fractures. Descriptive analyses were performed for each of the cohorts, and multivariate

regression was utilized to understand relationships between associated injuries and inhospital

mortality.

Results:

A total of 26,357 adult patients with femoral shaft fractures were analyzed. The

primary mechanisms of injury for these fractures were motor vehicle accidents and falls

(predominantly in those above 65 years of age). Generally, those with motor vehicle

accidents tended to be younger males with more associated injuries. Associated injuries

tended to concentrate based on proximity to the femoral shaft fracture. The highest

frequencies of associated injuries are the following: upper extremity (22.4%), thoracic

organ (19.5%), spine (16.8%), and intracranial (13.5%).

A total of 27,706 adult patients with tibial shaft fractures were analyzed. There

was a bimodal age distribution with peaks at 20 and 50 years of age. Falls were the most

common mechanism in the older age groups, while motor vehicle accidents dominated

the younger age groups. Overall, 59.6% of patients had at least one associated injury. The

highest frequencies of associated injuries are the following: upper extremity (16.3%),

spine (14.0%), thoracic organ (12.9%), and intracranial (11.3%). The presence of an

associated injury correlated with mortality (odds ratio = 12.9).

Conclusion:

Overall, the current study describes the cohorts of patients who sustain femoral

and tibial shaft fractures. The significant incidences and patterns associated with these

fractures are described. Furthermore, the significantly increased odds of mortality

associated with these injuries underscores the importance of recognizing and managing

associated injures in the trauma population.

Comments

This is an Open Access Thesis.

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