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.

ABSTRACT

PURPOSE: Early 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 METHODS: Consecutive 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. RESULTS: 114 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.). CONCLUSION: The 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.