Primärer Fixateur externe mit konsekutivem Verfahrenswechsel beim Polytrauma

Abstract

Immediate external fixation in multiply injured patients is fast and poor of complications. It is a expedient procedure which is safe and careful for critically ill patients. The required conversion procedure shows no raised rate of complications.

Evaluation of Criteria for Temporary External Fixation in Risk-Adapted Damage Control Orthopedic Surgery of Femur Shaft Fractures in Multiple Trauma Patients: ???Evidence-Based Medicine??? versus ???Reality??? in the Trauma Registry of the German Trauma Society

“…T oday, the optimal management of femur shaft fractures in multiple trauma patients is not yet resolved and may take one of the following three approaches: the primarydefinitive osteosynthesis by internal fixation in all patients, 1,2 the secondary-definitive internal osteosynthesis following temporary external fixation in all patients, 3 or the individualized concept of primary-or secondary-definitive osteosynthesis based on a risk-adapted decision-making process for damage control orthopedics. 4 In this respect, the debate further focuses on the prognostic factors influencing this decision.…”

“…Therefore, the question remains whether all patients should receive primary-definitive internal fracture osteosynthesis, 1,2 whether all patients should be treated by secondary-definitive internal osteosynthesis after temporary external fixation, 3 or whether an individualized selection process is necessary to determine the patients who may either undergo a primary-definitive procedure without risk or may benefit from a temporary stabilization before definitive osteosynthesis (risk-adapted damage control).…”

Developments in the understanding of staging a “major fracture” in polytrauma: results from an initiative by the polytrauma section of ESTES

“…Twenty-two (29.7%) studies investigated pelvic fractures in the polytraumatized patient and five studies focused pelvic fractures exclusively. Overall, 14 studies were published after [15] 54 One region only + + + Sturm et al [16] 207 One region only + + Johnson et al [17] 132 Multiple regions + + + + Seibel et al [18] 56 Multiple regions + + + + + Meek et al [19] 71 Multiple regions + + + Brug et al [20] 361 One region only + + Bone et al [4] 83 One region only + + + Burchardi et al [21] 225 Multiple regions + + + + Nast-Kolb et al [22] 69 One region only + + Hofman et al [23] 58 Multiple regions + + + + + Pelias et al [25] 130 Multiple regions + + + + Poole et al [26] 114 Multiple regions + + + Pape et al [24] 16 One region only + + Riemer et al [27] 150 One region only + + Pape et al [28] 106 One region only + + Pape et al [29] 319 One region only + + Bone et al [30] 676 Multiple regions + + + + + Malisano et al [32] 153 Multiple regions + + + + van Os et al [33] 27 Multiple regions + + + + + + + + Charash et al [31] 138 One region only + + Reynolds et al [34] 105 One region only + + + Van Der Made et al [35] 60 One region only + + Bosse et al [36] 453 One region only + + Boulanger et al [37] 149 One region only + + Schmidtmann et al [38] 17 One region only + + + Aufmkolk et al [39] 325 One region only + + McLain et al [40] 26 One region only + + Nowotarski et al [41] 54 One region only + + + Scalea et al [42] 327 One region only + + + + + Taeger et al [45] 45 Multiple regions + + + + + + + + Brundage et al [43] 674 One region only + + + Pape et al [44] 514 One region only + + + + + Bhandari et al [46] 1211 Multiple regions + + + Nau et al…”

Polytraumamanagement – Behandlung des Schwerverletzten in Schockraum und OP

“…Bei der Behandlung von Extremitätenverletzungen wird das DCO-Konzept mit Reposition und vorübergehender Stabilisierung der Frakturen durch Fixateur externe verfolgt. So kann ein zeitlich limitierter Rahmen während der Primärversorgung eingehalten und das Intervall bis zur definitiven Frakturstabilisierung (in der Regel nach etwa 5-10 Tagen) sicher überbrückt werden [34,69]. Außerdem ist mit einer geringeren chirurgisch induzierten systemischen Inflammationsreaktion zu rechnen.…”