Do Patients With Multiple System Injury Benefit From Early Fixation of Unstable Axial Fractures? The Effects of Timing of Surgery on Initial Hospital Course

Vallier, Heather A.; Super, Dennis M.; Moore, Timothy A.; Wilber, John H.

doi:10.1097/bot.0b013e3182820eba

Cited by 65 publications

(47 citation statements)

References 57 publications

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“…Time of hospital admission until the initiation of the operative procedure for femoral shaft fixation was documented as #12 hours or .12 hours, in consideration of previous literature. 8 In certain instances, patients with multiple traumatic injuries underwent nonorthopaedic procedures before definitive fixation of the femoral shaft. Patients who required an exploratory laparotomy were documented.…”

Section: Methodsmentioning

confidence: 99%

“…Subsequent literature supports the practice of definitive stabilization of femoral shaft fractures within 24 hours. [2][3][4][5][6][7][8] However, in an era of damage control orthopaedics, other investigations have offered different recommendations suggesting that hypoperfusion before early fixation is associated with increased mortality, 9 increased complications 10 and worse pulmonary function. [11][12][13] Lactic acidosis represents a state of hypoperfusion and is a predictor of multiple organ failure.…”

Section: Introductionmentioning

confidence: 99%

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The Role of Elevated Lactate as a Risk Factor for Pulmonary Morbidity After Early Fixation of Femoral Shaft Fractures

Richards¹,

Matuszewski²,

Griffin

et al. 2016

Journal of Orthopaedic Trauma

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Role of Elevated Lactate as a Risk Factor for Pulmonary Morbidity After Early Fixation of Femoral Shaft Fractures

Richards¹,

Matuszewski²,

Griffin

et al. 2016

Journal of Orthopaedic Trauma

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“…8,9,15,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] (Table 1) Coluna/Columna. 2015;14(2):152-6 …”

Section: Resultsmentioning

confidence: 99%

“…8,27,28,33,36,37 Mortality was reported in 16 studies, and was not taken into account in only two studies. 8,39 In the majority of studies, it was reported by fracture stabilization group (early vs. late), with a maximum percentage of 7.6% among the early treatment groups and 17% for the late groups.…”

Section: Fracture Fixation Approach and Techniquementioning

confidence: 99%

Damage control in thoracic and lumbar unstable fractures in polytrauma. Systematic review

Chávez¹,

Atanasio²,

García³

et al. 2015

Coluna/Columna

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The objective of this systematic review was to integrate the information from existing studies to determine the level of evidence and grade of recommendation of the implementation of damage control in unstable thoracic and lumbar fractures in polytraumatized patients. Eighteen papers were collected from different databases by keywords and Mesh terms; the level of evidence and grade of recommendation, the characteristics of the participants, the time of fracture fixation, the type of approach and technique used, the length of stay in the intensive care unit, the days of dependence on mechanical ventilator, and the incidence of complications in patients were assessed. The largest proportion of the studies were classified as level 4 evidence and grade C of recommendation which is favorable to the implementation of damage control in unstable thoracic and lumbar fractures in polytraumatized patients as a positive recommendation, although not conclusive. Most papers advocate fracture stabilization within 72 hours of the injury which is associated with a lower incidence of complications, hospital stay, stay in the intensive care unit and lower mortality. RESUMO O objetivo desta revisão sistemática foi integrar as informações dos estudos existentes para determinar o nível de evidência e grau de recomendação da aplicação do controle de danos em fraturas torácica e lombar instáveis em pacientes com politraumatismo. Foram incluídos 18 artigos encontrados em diferentes bancos de dados, usando-se palavras-chave e termos do MeSH; avaliaram-se: nível de evidência e grau de recomendação, características dos participantes, momento em que se realizou a fixação da fratura, tipo de acesso e a técnica utilizada, dias de permanência na unidade de terapia intensiva, os dias de dependência de ventilação mecânica e a incidência de complicações dos pacientes. A maior proporção de artigos foi classificada como nível 4 de evidência, com predomínio do grau C de recomendação, o que torna favorável à implementação do controle de danos em fraturas torácicas e lombares instáveis em pacientes com politraumatismo, não sendo, contudo, concludente. A maioria dos artigos preconiza a estabilização da fratura nas primeiras 72 horas da lesão, o que está associado a menor incidência de complicações, permanência hospitalar, permanência na unidade de terapia intensiva e a menor mortalidade. Descritores: Traumatismo múltiplo; Fraturas da coluna vertebral/cirurgia; Fixação de fratura; Vértebras lombares; Vértebras torácicas. RESUMEN El objetivo de esta revisión sistemática fue integrar la información de los estudios existentes para determinar el nivel de evidencia y grado de recomendación de la aplicación del control de daños en fracturas torácicas y lumbares inestables en pacientes politraumatizados. Se incluyeron 18 artículos localizados en diferentes bases de datos a través de palabras clave y términos del

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“…Многие исследования свидетельствуют о том, что ранний, в первые 24 ч после получения политравмы, окончательный остеосинтез бедренной кости оказы-вает противошоковый эффект, позволяет в короткие сроки активизировать пострадавших и уменьшить частоту системных осложнений: синдрома жировой эмболии [11], ОРДС, пневмонии [15], сепсиса, ТЭЛА и ПОН [16,[30][31][32]. Кроме того, сокращаются продолжи-тельность искусственной вентиляции легких (ИВЛ), пребывания пациента в отделении интенсивной тера-пии и общий срок стационарного лечения, существен-но улучшаются анатомо-функциональные результаты лечения [32,33].…”

Section: ранний остеосинтез и феномен «второго удара»unclassified

Advantages and Dangers of Early Osteosynthesis of Femur in Polytrauma With Chest Injur

Шапкин¹,

Seliverstov²

2017

Neotložnaâ med. pomoŝʹ

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ФГБОУ ВО «Саратовский государственный медицинский университет имени В.И. Разумовского» Министерства здраво-охранения Российской Федерации, Саратов, Российская Федерация * Контактная информация: Селиверстов Павел Андреевич, кандидат медицинских наук, ассистент кафедры общей хирургии ФГБОУ ВО Саратовский ГМУ им. В.И. Разумовского Минздрава России. E-mail: seliwerstov.pl@yandex.ru РЕЗЮМЕ В обзоре представлены результаты экспериментальных и клинических исследований влияния раннего остеосинтеза при переломе бедренной кости на развитие системных осложнений и ис-хода политравмы с повреждениями груди. Рассмотрена роль сочетания торакальных поврежде-ний с переломом бедренной кости, а также ее интрамедуллярного остеосинтеза в механизмах формирования местной и системной воспалительной реакции, коагулопатии, жировой и тромбо-эмболии в легких, дыхательной недостаточности. Изложены концепции «немедленной тотальной помощи», «контроля ортопедических повреждений» применительно к переломам бедренной кости, сочетанных с травмой груди. Приведены критерии относительной безопасности выпол-нения окончательного остеосинтеза бедренной кости при политравме с торакальными повреж-дениями. Ключевые слова:политравма, перелом бедренной кости, повреждения груди, легочные осложнения, «второй удар», воспалительный ответ, коагулопатия, контроль скелетных повреждений, интрамедулляр-ный остеосинтез Ссылка для цитирования Конфликт интересовАвторы заявляют об отсутствии конфликтов интересов БлагодарностиИсследование не имеет спонсорской поддержки ДНК -дезоксирибонуклеиновая кислота ИВЛ -искусственная вентиляция легких ОРДС -острый респираторный дистресс-синдром ПОН -полиорганная недостаточность СВР -системная воспалительная реакция ТЭЛА -тромбоэмболия легочной артерии

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Do Patients With Multiple System Injury Benefit From Early Fixation of Unstable Axial Fractures? The Effects of Timing of Surgery on Initial Hospital Course

Abstract: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 65 publications

References 57 publications

The Role of Elevated Lactate as a Risk Factor for Pulmonary Morbidity After Early Fixation of Femoral Shaft Fractures

The Role of Elevated Lactate as a Risk Factor for Pulmonary Morbidity After Early Fixation of Femoral Shaft Fractures

Damage control in thoracic and lumbar unstable fractures in polytrauma. Systematic review

Advantages and Dangers of Early Osteosynthesis of Femur in Polytrauma With Chest Injur

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