Trial reportAnnals of surgery2007
Impact of the method of initial stabilization for femoral shaft fractures in patients with multiple injuries at risk for complications (borderline patients).
Trial report in Annals of surgery, 2007. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 85 papers, 7 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
85 citing papers in PubMed, 7 syntheses or guidelines pooled it, 283 citations in OpenAlex.
- Optimal timing of stabilization and operative technique for extremity fractures in polytrauma patients: a systematic review and meta-analysis.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2025Pooled it
- Developments in the understanding of staging a "major fracture" in polytrauma: results from an initiative by the polytrauma section of ESTES.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2024Pooled it
- Heterogeneity in defining multiple trauma: a systematic review of randomized controlled trials.Critical care (London, England) · 2023Pooled it
- Timing of antibiotic administration, wound debridement, and the stages of reconstructive surgery for open long bone fractures of the upper and lower limbs.The Cochrane database of systematic reviews · 2022Pooled it
- Early versus late intramedullary nailing for traumatic femur fracture management: meta-analysis.Journal of orthopaedic surgery and research · 2018Pooled it
- Management of bleeding and coagulopathy following major trauma: an updated European guideline.Critical care (London, England) · 2013Pooled it
- Management of bleeding following major trauma: an updated European guideline.Critical care (London, England) · 2010Guideline
- Trial
- Trial
- [S3 guidelines on intensive care medicine following polytrauma : Aspects regarding definitive surgical treatment].Die Anaesthesiologie · 2026Review
- Article
- Evaluating Early Appropriate Care Criteria for Acute Axial and Lower Extremity Fractures: A Large Database Propensity-Matched Cohort Study.Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews · 2025Article
- Incidence and Functional Impact of Malrotation after Intramedullary Nailing of Femoral Shaft Fractures: A Prospective Computed Tomography-based Observational Study.Journal of orthopaedic case reports · 2025Article
- [S3 guidelines on intensive care medicine following polytrauma : Aspects regarding definitive surgical treatment].Unfallchirurgie (Heidelberg, Germany) · 2025Review
- Polytrauma Patients managed by Damage Control Orthopedics or Early Total Care - Assessment of Biomarkers.Journal of orthopaedic case reports · 2025Article
- Damage control orthopaedics is associated with impaired fracture healing and delayed recovery in a rodent model of severe multiple trauma.Bone & joint research · 2025Article
- A China-Based exploration of surgical timing for polytrauma with a focus on fracture reconstruction.World journal of emergency surgery : WJES · 2025Article
- Translating Biomarker Research into Clinical Practice in Orthopaedic Trauma: A Systematic Review.Journal of clinical medicine · 2025Review
- Veno-venous ECMO-assisted orthopedic stabilization for polytrauma with severe ARDS and refractory hypoxemia: a case report.Frontiers in medicine · 2025Article
- Pulmonary miRNA expression after polytrauma depends on the surgical invasiveness and displays an anti-inflammatory pattern by the combined inhibition of C5 and CD14.Frontiers in immunology · 2024Article
25 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
15 authors at 6 institutions in 5 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesThe timing of definitive fixation for major fractures in patients with multiple injuries is controversial. To address this gap, we randomized patients with blunt multiple injuries to either initial definitive stabilization of the femur shaft with an intramedullary nail or an external fixateur with later conversion to an intermedullary nail and documented the postoperative clinical condition.
methodsMultiply injured patients with femoral shaft fractures were randomized to either initial (<24 hours) intramedullary femoral nailing or external fixation and later conversion to an intramedullary nail. Inclusion: New Injury Severity Score >16 points, or 3 fractures and Abbreviated Injury Scale score > or =2 points and another injury (Abbreviated Injury Scale score > or =2 points), and age 18 to 65 years. Exclusion: patients in unstable or critical condition. Patients were graded as stable or borderline (increased risk of systemic complications). OUTCOMES: : Incidence of acute lung injuries.
resultsTen European Centers, 165 patients, mean age 32.7 +/- 11.7 years. Group intramedullary nailing, n = 94; group external fixation, n = 71. Preoperatively, 121 patients were stable and 44 patients were in borderline condition. After adjusting for differences in initial injury severity between the 2 treatment groups, the odds of developing acute lung injury were 6.69 times greater in borderline patients who underwent intramedullary nailing in comparison with those who underwent external fixation, P < 0.05.
conclusionIntramedullary stabilization of the femur fracture can affect the outcome in patients with multiple injuries. In stable patients, primary femoral nailing is associated with shorter ventilation time. In borderline patients, it is associated with a higher incidence of lung dysfunctions when compared with those who underwent external fixation and later conversion to intermedullary nail. Therefore, the preoperative condition should be when deciding on the type of initial fixation to perform in patients with multiple blunt injuries.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.