Retrospective analysis of treatment outcomes in polytrauma patients with multiple long bone fractures of lower extremities
DOI:
https://doi.org/10.12775/JEHS.2020.10.02.038Keywords
polytrauma, long bone fractures, definitive osteosynthesis, complication, outcomesAbstract
The aim: to conduct retrospective analysis of treatment outcomes in polytrauma patients with multiple long bone fractures of lower extremities.
Materials and methods: retrospective study of treatment results in patients hospitalized to the polytrauma department of Kyiv City Clinical Hospital №17 from January 2013 to December 2016.
Results: among patients with polytrauma and multiple long bone fractures of lower extremities, males dominated (67.9%) and the main cause of injury was a road accident (73.3%). The most common localizations of injuries were chest trauma (82.4%), traumatic brain injury (74.8%). The severity of injury was 29.2 ± 10.5 points according to the Injury Severity Score (ISS), degree of consciousness disorders was 9.1 ± 3.3 points in conformity with Glasgow Coma Scale (GCS). Patients developed complications, including nosocomial pneumonia (40.5%), acute respiratory distress syndrome (ARDS) (19.1%) and fat embolism syndrome (10.7%), as well as sepsis (28.2%) and multiple organ failure (MOF) (16.0%). Mortality rate was 24.4%.
Conclusion: It was found that among patients with polytrauma and multiple long bone fractures of lower extremities males dominated on the basis of gender, the main cause of injury was a road accident. The most common localizations of injuries were chest trauma and traumatic brain injury. Among controversial issues of treatment and diagnostic process are low frequency of pelvic binder application, ultrasound according to focused assessment with sonography for trauma (FAST) protocol and whole body multispiral computed tomography (WBMCT), which should be performed in 100.0% of patients with high-energy trauma at the time of admission to the hospital. In addition, frequency of Early Total Care (ETC) tactics application was too low, and definitive osteosynthesis in some cases was performed unreasonably late, using conservative fixation methods, which is a cause of complications and treatment prolongation in patients with polytrauma.
The most common complications were pulmonary: nosocomial pneumonia, ARDS and fat embolism syndrome. Mortality rate was 24.4%.
References
Rating the severity of tissue damage. I. The abbreviated scale. (1971). JAMA, 215(2), 277–280. https://doi.org/10.1001/jama.1971.03180150059012
Baker, S. P., O'Neill, B., Haddon, W., Jr, & Long, W. B. (1974). The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. The Journal of trauma, 14(3), 187–196.
Osler, T., Baker, S. P., & Long, W. (1997). A modification of the injury severity score that both improves accuracy and simplifies scoring. The Journal of trauma, 43(6), 922–926. https://doi.org/10.1097/00005373-199712000-00009
Teasdale, G., & Jennett, B. (1974). Assessment of coma and impaired consciousness. A practical scale. Lancet (London, England), 2(7872), 81–84. https://doi.org/10.1016/s0140-6736(74)91639-0
Pape, H. C., Giannoudis, P. V., Krettek, C., & Trentz, O. (2005). Timing of fixation of major fractures in blunt polytrauma: role of conventional indicators in clinical decision making. Journal of orthopaedic trauma, 19(8), 551–562. https://doi.org/10.1097/01.bot.0000161712.87129.80
Schurink, C., Nieuwenhoven, C., Jacobs, J. A., Rozenberg-Arska, M., Joore, H., Buskens, E., Hoepelman, A., & Bonten, M. (2004). Clinical pulmonary infection score for ventilator-associated pneumonia: accuracy and inter-observer variability. Intensive care medicine, 30(2), 217–224. https://doi.org/10.1007/s00134-003-2018-2
ARDS Definition Task Force, Ranieri, V. M., Rubenfeld, G. D., Thompson, B. T., Ferguson, N. D., Caldwell, E., Fan, E., Camporota, L., & Slutsky, A. S. (2012). Acute respiratory distress syndrome: the Berlin Definition. JAMA, 307(23), 2526–2533. https://doi.org/10.1001/jama.2012.5669
Gurd, A. R., & Wilson, R. I. (1974). The fat embolism syndrome. The Journal of bone and joint surgery. British volume, 56B(3), 408–416
Levy, M. M., Fink, M. P., Marshall, J. C., Abraham, E., Angus, D., Cook, D., Cohen, J., Opal, S. M., Vincent, J. L., Ramsay, G., & International Sepsis Definitions Conference (2003). 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Intensive care medicine, 29(4), 530–538. https://doi.org/10.1007/s00134-003-1662-x
Singer, M., Deutschman, C. S., Seymour, C. W., Shankar-Hari, M., Annane, D., Bauer, M., Bellomo, R., Bernard, G. R., Chiche, J. D., Coopersmith, C. M., Hotchkiss, R. S., Levy, M. M., Marshall, J. C., Martin, G. S., Opal, S. M., Rubenfeld, G. D., van der Poll, T., Vincent, J. L., & Angus, D. C. (2016). The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA, 315(8), 801–810. https://doi.org/10.1001/jama.2016.0287
Vincent, J. L., Moreno, R., Takala, J., Willatts, S., De Mendonça, A., Bruining, H., Reinhart, C. K., Suter, P. M., & Thijs, L. G. (1996). The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive care medicine, 22(7), 707–710. https://doi.org/10.1007/bf01709751
Toroyan, T., Peden, M. M., & Iaych, K. (2013). WHO launches second global status report on road safety. Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention, 19(2), 150. https://doi.org/10.1136/injuryprev-2013-040775
Halvachizadeh, S., Baradaran, L., Cinelli, P., Pfeifer, R., Sprengel, K., & Pape, H. C. (2020). How to detect a polytrauma patient at risk of complications: A validation and database analysis of four published scales. PloS one, 15(1), e0228082. https://doi.org/10.1371/journal.pone.0228082
Taylor, C. A., Bell, J. M., Breiding, M. J., & Xu, L. (2017). Traumatic Brain Injury-Related Emergency Department Visits, Hospitalizations, and Deaths - United States, 2007 and 2013. Morbidity and mortality weekly report. Surveillance summaries (Washington, D.C. : 2002), 66(9), 1–16. https://doi.org/10.15585/mmwr.ss6609a1
Bayer, J., Lefering, R., Reinhardt, S., Kühle, J., Südkamp, N. P., Hammer, T., & TraumaRegister DGU (2017). Severity-dependent differences in early management of thoracic trauma in severely injured patients - Analysis based on the TraumaRegister DGU®. Scandinavian journal of trauma, resuscitation and emergency medicine, 25(1), 10. https://doi.org/10.1186/s13049-017-0354-4
Advanced Trauma Life Support (ATLS) of the American College of Surgeons (ACS), Committee on Trauma. 10th Edition. (2018). 2-420.
Liu, X. Y., Jiang, M., Yi, C. L., Bai, X. J., & Hak, D. J. (2016). Early intramedullary nailing for femoral fractures in patients with severe thoracic trauma: A systemic review and meta-analysis. Chinese journal of traumatology = Zhonghua chuang shang za zhi, 19(3), 160–163. https://doi.org/10.1016/j.cjtee.2016.04.001
Nahm, N. J., & Vallier, H. A. (2012). Timing of definitive treatment of femoral shaft fractures in patients with multiple injuries: a systematic review of randomized and nonrandomized trials. The journal of trauma and acute care surgery, 73(5), 1046–1063. https://doi.org/10.1097/TA.0b013e3182701ded
Andruszkow, H., Dowrick, A. S., Frink, M., Zeckey, C., Krettek, C., Hildebrand, F., Edwards, E. R., & Mommsen, P. (2013). Surgical strategies in polytraumatized patients with femoral shaft fractures - comparing a German and an Australian level I trauma centre. Injury, 44(8), 1068–1072. https://doi.org/10.1016/j.injury.2013.03.032
Brundage, S. I., McGhan, R., Jurkovich, G. J., Mack, C. D., & Maier, R. V. (2002). Timing of femur fracture fixation: effect on outcome in patients with thoracic and head injuries. The Journal of trauma, 52(2), 299–307. https://doi.org/10.1097/00005373-200202000-00016
Nicola R. (2013). Early Total Care versus Damage Control: Current Concepts in the Orthopedic Care of Polytrauma Patients. ISRN orthopedics, 2013, 329452. https://doi.org/10.1155/2013/329452
Pallister, I, Francis, W.R, Stanley, J.C et al. (2012). Definitive major fracture surgery after damage control & in isolated injuries – a pragmatic approach to timing is safe. J Bone Joint Surg Br; (Suppl 18): 71
Nahm, N. J., Moore, T. A., & Vallier, H. A. (2014). Use of two grading systems in determining risks associated with timing of fracture fixation. The journal of trauma and acute care surgery, 77(2), 268–279. https://doi.org/10.1097/TA.0000000000000283
Steinhausen, E., Lefering, R., Tjardes, T., Neugebauer, E. A., Bouillon, B., Rixen, D., & Committee on Emergency Medicine, Intensive and Trauma Care (Sektion NIS) of the German Society for Trauma Surgery (DGU) (2014). A risk-adapted approach is beneficial in the management of bilateral femoral shaft fractures in multiple trauma patients: an analysis based on the trauma registry of the German Trauma Society. The journal of trauma and acute care surgery, 76(5), 1288–1293. https://doi.org/10.1097/TA.0000000000000167
Kobbe, P., Micansky, F., Lichte, P., Sellei, R. M., Pfeifer, R., Dombroski, D., Lefering, R., Pape, H. C., & TraumaRegister DGU (2013). Increased morbidity and mortality after bilateral femoral shaft fractures: myth or reality in the era of damage control?. Injury, 44(2), 221–225. https://doi.org/10.1016/j.injury.2012.09.011
Lichte, P., Weber, C., Sellei, R. M., Hildebrand, F., Lefering, R., Pape, H. C., Kobbe, P., & TraumaRegister DGU (2014). Are bilateral tibial shaft fractures associated with an increased risk for adverse outcome?. Injury, 45(12), 1985–1989. https://doi.org/10.1016/j.injury.2014.10.005
Willett, K., Al-Khateeb, H., Kotnis, R., Bouamra, O., & Lecky, F. (2010). Risk of mortality: the relationship with associated injuries and fracture treatment methods in patients with unilateral or bilateral femoral shaft fractures. The Journal of trauma, 69(2), 405–410. https://doi.org/10.1097/TA.0b013e3181e6138a
Downloads
Published
How to Cite
Issue
Section
License
The periodical offers access to content in the Open Access system under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0
Stats
Number of views and downloads: 451
Number of citations: 0
