A study published online in the journal PLoS Medicine examines trends in the timing of femoral shaft fracture fixation following major trauma. 

The researchers conducted a retrospective, cohort study of 17,993 patients who underwent definitive fixation across 216 trauma centers. They found that the median time to fixation was 15 hours, with delayed fixation (≥24 hours) performed in 26 percent of patients. After adjustment, the researchers identified 57 hospitals (26 percent) as outliers, reflecting significant practice variation unexplained by patient case mix. Compared to hospitals in the lowest quartile of delayed fixation, patients treated at hospitals in the highest quartile experienced 2-fold higher rates of pulmonary embolism (PE) and required longer length of stay but saw no significant difference with respect to mortality. The researchers write that "trauma centers should strive to minimize delays in fixation, and quality improvement initiatives should emphasize this recommendation in best practice guidelines." Learn more...

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