The lack of association between femoral shaft fractures and hypotensive shock.

A retrospective review of all patients with femur fractures was performed to determine whether isolated femoral shaft fractures were associated with hypotensive shock. One hundred patients were identified who had either an isolated femoral shaft fracture (group F, 62 patients) or a femoral shaft fracture in addition to other non-shock producing fractures or minor injuries (group A, 38 patients). No patients in this study were in class III or IV (hypotensive) shock; however, 11% progressed from no shock to class I and 13% from class I to class II. Logistic regression showed no association between class II shock and age, sex, or weight. The presence of additional fractures (p = 0.004) and total fluids received from fracture to stabilization (p = 0.014) had a highly significant association with class II shock in a joint analysis. Mechanism of injury, although significant as an independent variable, was highly associated with the presence of additional fractures and so is not required in the joint model. Femur fractures alone or in combination with other minor injuries should not be considered the cause of hypotensive shock in the traumatized patient. In the traumatized patient who presents with a closed femoral shaft fracture and hypotension, an alternative source of hemorrhage should be sought.

Should comminuted trochanteric fractures of the hip in the elderly be reduced before fixation?

Twenty patients with comminuted trochanteric fractures underwent fixation in the position of deformity. We explain the principles and rationale of this technique and analyse our results.