NOVA. The University of Newcastle's Digital Repository

Please use this identifier to cite or link to this item: http://hdl.handle.net/1959.13/930057

Title

Acute definitive internal fixation of pelvic ring fractures in polytrauma patients: a feasible option

Author/Creator

Enninghorst, Natalie;  Toth, Laszlo;  King, Kate L.;  McDougall, Debra;  Mackenzie, Stuart;  Balogh, Zsolt J.

Institution

The University of Newcastle. Faculty of Health, School of Medicine and Public Health

Description

Background: Staged surgery is recommended for the management of multiple injuries-associated high-energy pelvic ring fractures (acute temporary skeletal stabilization is followed by definitive internal fixation [ORIF]). Acute definitive internal fixation is a controversial topic. The purpose of this study was to evaluate the safety and efficiency of acute pelvic ORIF by comparing its short-term outcomes with those who had staged surgery. Methods: A 43-month retrospective review of the prospective pelvic fracture database of a level-1 trauma center was performed. Consecutive high-energy trauma patients who sustained a fracture that was suitable for minimally invasive internal fixation (iliosacral screw fixation and symphyseal plating) were included. Patients were categorized as acute ORIF (<24 hours) or staged late ORIF (>24 hours). Demographics, Injury Severity Score, pelvic Abbreviated Injury Score, first 24-hour transfusions, physiologic parameters, time to operating room (OR), angiography requirement, length of stay (LOS), and mortality were recorded. Data are presented as mean ± SD or percentages. Statistical significance was determined at p < 0.05 based on univariate analysis. Results: Forty-five patients met inclusion criteria, 18 patients had acute definitive ORIF (5.5 hours to OR) and 27 had late definitive ORIF (5 days to OR). Acute and late ORIF patients had comparable demographics (age: 48 ± 22 years vs. 40 ± 14 years, gender: 82% vs. 79% men) and injury severity (Injury Severity Score: 30 ± 18 vs. 24.5 ± 13, pelvic Abbreviated Injury Score: 3.7 ± 1 vs. 3.4 ± 1.1). Initial shock parameters were significantly worse in the acute ORIF group (systolic blood pressure, 69.7 ± 17 mm Hg vs. 108 ± 21 mm Hg; BD, −7.4 ± 4 vs. −4.9 ± 2 mEq/L, lactate 6.67 ± 7 mmol/L vs. 2.51 ± 1.3 mmol/L). Angiography was used in 18% (3/18) vs. 21% (6 of 27) of the cases. All early ORIF patients survived and one (3%) of the late ORIF patients died. There was a trend to shorter hospital LOS (25 ± 24 days vs. 37 ± 32 days) and a decreased 24-hour red cell transfusion rate (4.7 ± 5 U vs. 6.6 ± 4 U) in the early ORIF group. The intensive care unit admission rate (12 of 18 vs. 15 of 27) and LOS was comparable (2.9 ± 2.5 days vs. 3.7 ± 3.6 days). Conclusion: Acute ORIF of unstable pelvic ring fractures within 6 hours could be safely performed even in severely shocked patients with multiple injuries. The procedure did not lead to increased rates of transfusion, mortality, intensive care unit LOS, or overall LOS. Furthermore, all these parameters showed a trend toward benefit compared with a staged approach.

Relation

Journal of Trauma: Injury, Infection and Critical Care Vol. 68, Issue 4, p. 935-941

Publisher Link

http://dx.doi.org/10.1097/TA.0b013e3181d27b48

Date

2010

Publisher

Lippincott Williams & Wilkins

Keyword(s)

damage control;  damage control orthopaedics;  early fixation;  internal fixation;  multiple injuries;  outcome;  pelvic fracture

Resource Type

journal article

Identifier

http://hdl.handle.net/1959.13/930057

Identifier

ISSN:0022-5282

---

Reviewed

Save/E-mail Citation

Citation Format

Plain Text Citation HTML Citation EndNote Format

E-mail Address

Subject

"Journal of Trauma: Injury, Infection and Critical Care"

 

OR