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The timing of definitive fixation for major fractures in polytrauma—A matched-pair comparison between a US and European level I centres: Analysis of current fracture management practice in polytrauma |
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| Authors: | Verena M Schreiber Sophie Darwiche Jaques Chelly Hans-Christoph Pape |
| Institution: | a Department of Orthopaedic Surgery, Division of Trauma, University of Pittsburgh, Pittsburgh, USA b Department of Trauma Surgery, Hannover Medical School, Hannover, Germany c Department of Anesthesiology, University of Pittsburgh, Pittsburgh, USA d Department of Orthopaedic and Trauma Surgery, Medical Faculty, RWTH Aachen University, Aachen, Germany e Department of Orthopaedic and Trauma Surgery, Medical Faculty, University of Leeds, GB, England |
| Abstract: | PurposeEarly definitive stabilisation is usually the treatment of choice for major fractures in polytrauma patients. Modifications may be made when patients are in critical condition, or when associated injuries dictate the timing of surgery. The current study investigates whether the timing of fracture treatment is different in different trauma systems.Materials and methodsConsecutive patients treated a Level I trauma centre were documented (Group US) and a matched-pair group was gathered from the German Trauma Registry (Group GTR). Inclusion criteria: New Injury Severity Score (NISS) > 16, >2 major fractures and >1 organ/soft tissue injury. The timing and type of surgery for major fractures was recorded, as were major complications.Results114 patients were included, n = 57 Group US (35.1% F, 64.9% M, mean age: 44.1 yrs ± 16.49, mean NISS: 27.4 ± 8.65, mean ICU stay: 10 ± 7.49) and n = 57 Group GTR (36.8% F, 63.1% M, mean age: 41.2 yrs ± 15.35, mean NISS: 29.4 ± 6.88, mean ICU stay: 15.6 ± 18.25). 44 (57.1%) out of 77 fractures in Group US received primary definitive fracture fixation compared to 61 (65.5%) out of 93 fractures in Group GTR (n.s.). The average duration until definitive treatment was comparable in all major extremity fractures (pelvis: 5 days ± 2.8 Group US, 7.1 days ± 9.6 Group GTR (n.s.), femur: 7.9 days ± 8.3 Group US, 5.5 days ± 7.9 (n.s.), tibia: 6.2 days ± 5.6 Group US, 6.2 days ± 9.1 Group GTR (n.s.), humerus: 5 days ± 3.7 Group US, 6.6 days ± 6.1 Group GTR (n.s.), radius: 6 days ± 4.7 Group US, 6.1 days ± 8.7 Group GTR (n.s.).ConclusionThe current matched-pair analysis demonstrates that the timing of initial definitive fixation of major fractures is comparable between the US and Europe. Certain fractures are stabilised internally in a staged fashion regardless the trauma system, thus discounting previous apparent contradictions. |
| Keywords: | Polytrauma Operative treatment Major fractures Femoral shaft fractures Humeral shaft fractures External fixation Extremity fracture Pelvic fracture |
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