Early versus delayed stabilization of femoral fractures. A prospective randomized study.

Bone, Lawrence B.; Johnson, Kenneth D.; Weigelt, John A.; Scheinberg, Robert

doi:10.2106/00004623-198971030-00004

Cited by 709 publications

(239 citation statements)

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“…These studies advocate the model of "early total care" (ETC). This model of early definitive care was also thought to be of benefit in patients with thoracic trauma [35,36]. This rule, however, seems to have only limited validity in these patients.…”

Section: Strategy Of Fracture Care In Case Of Simultaneously Existingmentioning

confidence: 99%

Diagnostics and Scoring in Blunt Chest Trauma

Hildebrand

Griensven

Garapati

et al. 2002

European Journal of Trauma

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Background: Blunt chest trauma is frequently present in patients with multiple trauma. In polytraumatized patients thoracic injuries have significant influence on the treatment strategy, not only in the emergency room but also in the intensive care unit. They also affect the decision-making concerning fracture management. The vital role played by blunt chest trauma in the outcome after multiple injuries is highlighted by the fact that polytraumatized patients with severe thoracic trauma have a higher mortality rate than patients with the same injury severity without thoracic trauma. Diagnostics and Injury Severity: Within the broad category of thoracic trauma, there are many different types of injuries. Therefore it is crucial for the treating physician to promptly make the correct diagnosis and to quantify the severity of the injury. This will allow the selection of an appropriate treatment protocol and ensure the best possible outcome for the patient. Scoring Systems: Additionally, various treatment protocols for management can only be evaluated scientifically if the assessment of the trauma severity is standardized. Thus, a reliable CT-independent classification of the severity of thoracic trauma is essential. The "Thoracic Trauma Severity Score" (TTS) is a CT-independent classification of thoracic trauma that is reliable and can be performed quickly in the emergency room. This will allow for adequate treatment of thoracic trauma and the prevention of secondary complications.

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Section: Strategy Of Fracture Care In Case Of Simultaneously Existingmentioning

confidence: 99%

Diagnostics and Scoring in Blunt Chest Trauma

Hildebrand

Griensven

Garapati

et al. 2002

European Journal of Trauma

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“…In patients with severe thoracic trauma, delaying stabilization of femur fractures led to an increase in pulmonary complications from 16 to 56% [8]. Bone et al [9] showed in a randomized trial that early stabilization of femur fractures decreased the incidence of pulmonary complications. In our case, rigid stabilization of the pelvic fracture was postponed for three days.…”

Section: Discussionmentioning

confidence: 99%

A Lethal Case of Fat Embolism Syndrome in a Nine-Year-Old Child: Options for Prevention

Teeuwen

Sloots

Blaauw

et al. 2008

Eur J Trauma Emerg Surg

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We report a lethal case of fat embolism syndrome in a nine-year-old child after a direct blunt trauma leading to a pelvic fracture. On the second day, signs of bowel perforation and septic shock led to an acute aggravation of the pulmonary symptoms, cardiac arrest and death. Fat embolism is seldom thought to occur in pediatric trauma patients; however, this case illustrates it can lead to disastrous sequela. Since there is no specific treatment for it, prevention by early fracture stabilization is the only option.

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“…The concept of ''too sick to operate'' has been questioned from both sides of the Atlantic [4,5] and Bone et al [6] marked the beginning of ETC in a randomised trial.…”

Section: Historical Perspectivementioning

confidence: 99%

“…The gold standard for multiple long-bone fractures is stabilisation in the first 24 h [6,26,63]. The debate regarding Physiological assessment of the polytrauma patient 563 DCO versus ETC is currently ongoing, especially in patients with head and chest injuries, where ETC is thought to be potentially harmful [13,14,64].…”

Section: Multiple Skeletal Injuriesmentioning

confidence: 99%

Physiological assessment of the polytrauma patient: initial and secondary surgeries

Enninghorst

Peralta

Yoshino

et al. 2011

Eur J Trauma Emerg Surg

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The timing of fracture fixation in polytrauma patients has been debated for a long time. The decision between DCO (damage control orthopaedics) and ETC (early total care) is a difficult dilemma. Overzealous ETC in haemodynamically compromised patients with significant chest and head injuries can be detrimental. It has been shown, however, that early fracture fixation has a trend towards better outcome in patients with less severe injuries. Delaying all orthopaedic surgery in critically injured patients can be a safe alternative, but has several disadvantages like longer ICU stay and septic complications. The literature shows equivocal evidence for both settings. This article will summarize the historical background and controversies regarding patient assessment and decision making during the treatment of polytrauma patients. It will also give guidance for choosing DCO versus ETC in the clinical setting.

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Early versus delayed stabilization of femoral fractures. A prospective randomized study.

Cited by 709 publications

References 0 publications

Diagnostics and Scoring in Blunt Chest Trauma

Diagnostics and Scoring in Blunt Chest Trauma

A Lethal Case of Fat Embolism Syndrome in a Nine-Year-Old Child: Options for Prevention

Physiological assessment of the polytrauma patient: initial and secondary surgeries

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