Blunt XXXX (ISS 36), femur traction, and the @entity358 -septic state.

@entity1 @entity174 @entity26 @entity358 @entity1230 @entity881 @entity221 @entity491
Fifty-six blunt @entity1230 @entity1 (HTI-ISS 22-57) were studied for the effects of immediate versus delayed internal fixation of a femur or acetabular @entity174 on the @entity358 septic state. The @entity358 septic state may be defined as an alveolar arterial @entity26 tension difference greater than 100, plus @entity221 and @entity491 . These @entity1 were divided into four groups. Group I (N = 20) had immediate internal fixation, postoperative ventilatory support, and was sitting up at 30 hours. Group II (N = 20) had 10 days of femur traction and postoperative ventilatory support. Group III (N = 9) was immediately extubated after surgery and had 30 days of femur traction. Group IV (N = 7) had special circumstances that should increase the duration of the @entity358 septic state. These four groups of @entity1 were statistically identical by 20 different criteria on admission except that Group I had more recognized chest injuries than Group II (12 vs. 9). Group I required 3.4 +/- 2.6 days of ventilator support and 7.5 +/- 3.8 intensive care unit (ICU) days; they had 12 +/- 8.8 elevated white counts, 3.8 +/- 4 febrile days, 0.05 positive blood cultures per @entity1 , four @entity174 complications out of 93 @entity174 , 59 injections of narcotics, and 23 +/- 8.6 acute care days. Ten days of femur traction doubled the duration of the @entity358 septic state relative to Group I at a statistically significant level for nine out of 10 criteria, while increasing the number of positive blood cultures by a factor of 10, the number of @entity174 complications by a factor of 3.5, and the use of injectable narcotics by a factor of 2. Thirty days of femur traction increased the duration of the @entity358 septic state relative to Group I by a factor of 3 to 5 for all criteria at a statistically significant level, while increasing @entity174 complications by a factor of 17, positive blood cultures by a factor of 74, and the use of narcotics by a factor of 2. Group IV, which had four out of seven immediate internal fixations, behaved similarly to Group II. Femoral shaft traction should be avoided in the blunt @entity1230 @entity1 because it greatly increases the cost of care and the risk of @entity881 .(ABSTRACT TRUNCATED AT 400 WORDS)
