SRS32 - Early <i>versus</i> delayed fixation of femoral shaft fractures in polytrauma patients: a prospective multicenter study

Abstract Introduction The timing of definitive fixation of femoral shaft fractures in polytrauma patients remains controversial. While early fixation may reduce complications associated with prolonged immobilization, concerns about the ‘second hit’ phenomenon persist. This study aims to compare clinical outcomes between early (&amp;lt;24 h) and delayed (≥24 ) intramedullary nailing (IMN) in multiply injured patients. Methods A prospective multicenter cohort study was conducted across six level-1 trauma centers between 2019 and 2023. A total of 462 adult patients with femoral shaft fractures and Injury Severity Score (ISS) ≥16 were included. Patients were grouped based on timing of IMN: early (n = 278) and delayed (n = 184). Primary outcomes included incidence of acute respiratory distress syndrome (ARDS), length of intensive care unit (ICU) stay, and in-hospital mortality. Multivariate analysis adjusted for age, ISS, and hemodynamic stability. Results ARDS incidence was significantly lower in the early fixation group (7.6 versus 14.7%, P = 0.018), with shorter mean ICU stays (4.2 versus 6.8 days, P &amp;lt; 0.001). No significant difference in mortality was observed (early: 6.1%, delayed: 7.6%, P = 0.51). Early fixation was independently associated with reduced odds of ARDS (adjusted OR 0.48, 95% c.i. 0.26–0.88). Conclusions Early intramedullary fixation of femoral shaft fractures in polytrauma patients is associated with reduced pulmonary complications and shorter ICU stays without increasing mortality. These findings support early definitive management in hemodynamically stable patients, reinforcing the role of time-sensitive orthopedic intervention in trauma care. Further randomized studies are needed to confirm causality.