Surgical Stabilization of Femur Fractures in Post-Traumatic Hypoxemic Patients: When and Why?

BACKGROUND Post-traumatic hypoxemia can deteriorate during operative manipulations. OBJECTIVES In the present study, criteria-based approach was applied to determine optimum conditions for femur surgery. The aim of this study was to optimize perioperative management of post-traumatic hypoxemia. PATIENTS AND METHODS In this prospective observational study, post-traumatic adults with PaO2 < 70 mmHg in room air were enrolled. Physiological parameters, O2 saturation (SO2), arterial blood gas (ABG) analysis, Schonfeld fat embolism index score (SS), and Murray's lung injury scores (LIS) were assessed. The management protocol was femur surgery when patient was hemodynamically stable with LIS < 2.5 and PaO2/FiO2 > 200 mmHg (FiO2 < 0.5, PEEP < 8 cm H2O). RESULTS A total of 31 adults (26 males and 5 females) with LIS of 0.1 to 2.5 (26 patients) and > 2.5 (five patients) at admission were recruited. Sixteen patients were admitted within 24 hours and 15 between 24 and 90 hours after injury. Thirteen patients were operated within 24 hours. Post-operative LIS was improved. No adverse sequels or mortality were seen. CONCLUSIONS Appropriate surgical stabilization can be safely performed during established post-traumatic hypoxemia using a multidisciplinary approach, continuous monitoring, and serial investigations to diagnose fulminant pathology and associated injuries.