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The Journal of Bone and Joint Surgery 83:293 (2001)
© 2001 The Journal of Bone and Joint Surgery, Inc.

Letters to The Editor

Timing of Femoral Fracture Stabilization

Adam J. Starr, MD and Vernon T. Tolo, MD

To The Editor:

I enjoyed Dr. Tolo's Instructional Course Lecture "Orthopaedic Treatment of Fractures of the Long Bones and Pelvis in Children Who Have Multiple Injuries" (82-A: 272-280, Feb. 2000).

Concerning the timing of treatment of multiple closed fractures, I agree with Dr. Tolo's statement: "There is much less concern about pulmonary disease developing in children after multiple injuries . . . ". However, I disagree with the statement that followed: " . . . unless the child has sustained severe trauma to the chest or multiple fractures of the ribs."

We recently published a study of early versus delayed stabilization of femoral fractures in pediatric patients1. We found that pulmonary complications (pneumonia or respiratory distress syndrome) arose only if the patient had sustained a concomitant central nervous-system injury. In our series, thirteen patients developed respiratory complications. Twelve of these patients had a Glasgow Coma Score of 8 points or . . . [Full Text of this Article]


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