1: Ann Surg  1985 Sep;202(3):283-95 

Blunt multiple trauma (ISS 36), femur traction, and the pulmonary failure-septic
state.

Seibel R, LaDuca J, Hassett JM, Babikian G, Mills B, Border DO, Border JR.

Fifty-six blunt multiple trauma patients (HTI-ISS 22-57) were studied for the
effects of immediate versus delayed internal fixation of a femur or acetabular
fracture on the pulmonary failure septic state. The pulmonary failure septic
state may be defined as an alveolar arterial oxygen tension difference greater
than 100, plus fever and leukocytosis. These patients were divided into four
groups. Group I (N = 20) had immediate internal fixation, postoperative
ventilatory support, and was sitting up at 30 hours. Group II (N = 20) had 10
days of femur traction and postoperative ventilatory support. Group III (N = 9)
was immediately extubated after surgery and had 30 days of femur traction. Group
IV (N = 7) had special circumstances that should increase the duration of the
pulmonary failure septic state. These four groups of patients were statistically
identical by 20 different criteria on admission except that Group I had more
recognized chest injuries than Group II (12 vs. 9). Group I required 3.4 +/- 2.6
days of ventilator support and 7.5 +/- 3.8 intensive care unit (ICU) days; they
had 12 +/- 8.8 elevated white counts, 3.8 +/- 4 febrile days, 0.05 positive
blood cultures per patient, four fracture complications out of 93 fractures, 59
injections of narcotics, and 23 +/- 8.6 acute care days. Ten days of femur
traction doubled the duration of the pulmonary failure septic state relative to
Group I at a statistically significant level for nine out of 10 criteria, while
increasing the number of positive blood cultures by a factor of 10, the number
of fracture complications by a factor of 3.5, and the use of injectable
narcotics by a factor of 2. Thirty days of femur traction increased the duration
of the pulmonary failure septic state relative to Group I by a factor of 3 to 5
for all criteria at a statistically significant level, while increasing fracture
complications by a factor of 17, positive blood cultures by a factor of 74, and
the use of narcotics by a factor of 2. Group IV, which had four out of seven
immediate internal fixations, behaved similarly to Group II. Femoral shaft
traction should be avoided in the blunt multiple trauma patients because it
greatly increases the cost of care and the risk of multiple systems organ
failure.(ABSTRACT TRUNCATED AT 400 WORDS)

PMID: 4037903 [PubMed - indexed for MEDLINE]