Timing of diaphyseal femur fracture nailing: Is the difference night and day?

Neeraj M. Patel, Richard S. Yoon, John D. Koerner, Derek J. Donegan, Frank A. Liporace*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Introduction Most hospitals are faced with reduced personnel, resources, and provider fatigue or shift changes when day turns to night. For these reasons, some have suggested that diaphyseal femur fractures should be fixed during the daytime. The purpose of this study is to determine whether the time of surgery affects the post-operative difference in femoral version (DFV) and femoral length (DFL) between the fixed and uninjured sides following intramedullary nailing (IMN). Materials and methods Over a 10-year period, 340 patients underwent IMN of a diaphyseal femur fracture (AO types 32-A to C) with a post-operative computed tomography scanogram for version measurement. Demographic and surgical data, including time operated was collected. "Daytime" was defined as 7:00 AM to 6:59 PM, while the remainder of the clock was "nighttime". Additionally, the night hours were split into 3 consecutive 4-h categories for further analysis. Stepwise, multivariate regressions were used to evaluate any effect of time of surgery on post-operative DFV or DFL. Other variables included in these statistical models were age, sex, mechanism of injury, open vs. closed fracture, trauma vs. non-trauma surgeon, and AO and Winquist classifications. Results Overall, 22.4% (76/340) of all fractures were fixed at night. The mean post-operative DFV and DFL from the uninjured side in these patients was 8.9 and 4.1 mm, respectively, compared to 9.0 and 4.8 mm in those treated during the daytime. This difference was not statistically significant when accounting for other factors (p > 0.05). There was no statistically significant difference in patients with >10 mm limb length discrepancy or >15 degrees DFV (p = 1.0 for both). Conclusion The time of day at which diaphyseal femur fractures are treated does not have an impact on post-operative femoral version or length. While certain other injuries may be better handled during daytime hours, acceptable IMN of mid-shaft femur fractures may be achieved during all hours at a level 1 trauma centre.

Original languageEnglish (US)
Pages (from-to)546-549
Number of pages4
Issue number3
StatePublished - Mar 2014


  • Femoral length
  • Femoral shaft fracture
  • Femoral version
  • Intramedullary nail
  • Limb length discrepancy
  • Time of day

ASJC Scopus subject areas

  • Emergency Medicine
  • Orthopedics and Sports Medicine

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