Date of Award
Open Access Thesis
Medical Doctor (MD)
Jonathan N. Grauer
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.
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
2. To determine the relationship between associated injuries and in-hospital
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
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).
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.
Anandasivam, Nidharshan, "Demographics, Mechanism Of Injury, Injury Severity, And Associated Injury Profiles Of Patients With Femoral And Tibial Shaft Fractures: A Study Of The National Trauma Databank" (2019). Yale Medicine Thesis Digital Library. 3473.
This Article is Open Access