Systemic Inflammatory Response After Extremity or Truncal Fracture Operations

Pape, Hans-Christian; Griensven, Martijn van; Hildebrand, Frank; Tzioupis, Chris; Sommer, Katharina; Krettek, Christian; Giannoudis, Peter V.

doi:10.1097/ta.0b013e31818c8e8c

Cited by 46 publications

(32 citation statements)

References 28 publications

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“…Most authors agree that patients in severe traumatic-hemorrhagic shock from bleeding pelvic ring disruptions are unlikely candidates for early definitive pelvic fracture fixation, due to the inherent risk of increased mortality from exsanguinating hemorrhage and the “lethal triad” of coagulopathy, acidosis and hypothermia [22, 146]. A prospective multicenter cohort study revealed a significantly increased extent of blood loss and increased interleukin (IL-6 and IL-8) serum levels, reflective of an exacerbated systemic inflammatory response, in politrauma patients who underwent early pelvic fracture fixation on the first or second day post injury [147]. The early timing and short duration of initial pelvic stabilization revealed to have a positive impact on decreasing the incidence of multiple organ failure (MOF) and mortality [148].…”

Section: Methodsmentioning

confidence: 99%

Pelvic trauma: WSES classification and guidelines

et al. 2017

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Complex pelvic injuries are among the most dangerous and deadly trauma related lesions. Different classification systems exist, some are based on the mechanism of injury, some on anatomic patterns and some are focusing on the resulting instability requiring operative fixation. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic impairment of pelvic ring function and the associated injuries. The management of pelvic trauma patients aims definitively to restore the homeostasis and the normal physiopathology associated to the mechanical stability of the pelvic ring. Thus the management of pelvic trauma must be multidisciplinary and should be ultimately based on the physiology of the patient and the anatomy of the injury. This paper presents the World Society of Emergency Surgery (WSES) classification of pelvic trauma and the management Guidelines.

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Section: Methodsmentioning

confidence: 99%

Pelvic trauma: WSES classification and guidelines

et al. 2017

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“…Although numerous basic science studies in orthopedics have suggested that orthopedic trauma injuries may be associated with immune responses that facilitate sepsis [15–18], it is currently unclear whether orthopedic trauma patients are at increased risk for developing sepsis or septic shock. Existing studies have correlated trauma to large groups of adverse events, making it difficult to extrapolate associations to septic complications [19–22]. However, the relationship between sepsis and high mortality, its enormous financial costs, and the increasing emphasis on quality metrics make it imperative that orthopedic surgeons are able to identify trauma patients who may be more likely to develop the condition.…”

Section: Introductionmentioning

confidence: 99%

Incidence and predictive risk factors of postoperative sepsis in orthopedic trauma patients

et al. 2016

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BackgroundPostoperative sepsis is associated with high mortality and the national costs of septicemia exceed those of any other diagnosis. While numerous studies in the basic orthopedic science literature suggest that traumatic injuries facilitate the development of sepsis, it is currently unclear whether orthopedic trauma patients are at increased risk. The purpose of this study was thus to assess the incidence of sepsis and determine the risk factors that significantly predicted septicemia following orthopedic trauma surgery.Materials and methods56,336 orthopedic trauma patients treated between 2006 and 2013 were identified in the ACS-NSQIP database. Documentation of postoperative sepsis/septic shock, demographics, surgical variables, and preoperative comorbidities was collected. Chi-squared analyses were used to assess differences in the rates of sepsis between trauma and nontrauma groups. Binary multivariable regressions identified risk factors that significantly predicted the development of postoperative septicemia in orthopedic trauma patients.ResultsThere was a significant difference in the overall rates of both sepsis and septic shock between orthopedic trauma (1.6%) and nontrauma (0.5%) patients (p < 0.001). For orthopedic trauma patients, ventilator use (OR = 15.1, p = 0.002), history of pain at rest (OR = 2.8, p = 0.036), and prior sepsis (OR = 2.6, p < 0.001) were significantly associated with septicemia. Statistically predictive, modifiable comorbidities included hypertension (OR = 2.1, p = 0.003) and the use of corticosteroids (OR = 2.1, p = 0.016).ConclusionsThere is a significantly greater incidence of postoperative sepsis in the trauma cohort. Clinicians should be aware of these predictive characteristics, may seek to counsel at-risk patients, and should consider addressing modifiable risk factors such as hypertension and corticosteroid use preoperatively. Level of evidence Level III.

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“…Our aim was to mimic severe trauma from a large long bone (femur) fracture, in which soft tissue injury and the release of bone components are present at the same time. We induced fibula fracture to simulate the stress of long bone fracture, but unlike a femur fracture, this manipulation does not necessitate fixation surgery that could exacerbate outcomes (37,39). Because the fibula is very small, we injected additional bone components to the injured area as described in previous studies (35, 36a, 48).…”

Section: Severe Orthopedic Trauma Protocolsmentioning

confidence: 99%

β₂-Adrenoreceptor blockade improves early posttrauma hyperglycemia and pulmonary injury in obese rats

Xiang

Mittwede

et al. 2014

American Journal of Physiology-Heart and Circulatory Physiology

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Xiang L, Lu S, Mittwede PN, Clemmer JS, Husband GW, Hester RL. ␤ 2-Adrenoreceptor blockade improves early posttrauma hyperglycemia and pulmonary injury in obese rats. Am J Physiol Heart Circ Physiol 307: H621-H627, 2014. First published June 14, 2014; doi:10.1152/ajpheart.00208.2014.-Early hyperglycemia after trauma increases morbidity and mortality. Insulin is widely used to control posttrauma glucose, but this treatment increases the risk of hypoglycemia. We tested a novel method for early posttrauma hyperglycemia control by suppressing hepatic glycogenolysis via ␤ 2-adrenoreceptor blockade [ICI-118551 (ICI)]. We have shown that, after severe trauma, obese Zucker (OZ) rats, similar to obese patients, exhibit increased acute lung injury compared with lean Zucker (LZ) rats. We hypothesized that OZ rats exhibit a greater increase in early posttrauma glucose compared with LZ rats, with the increased posttrauma hyperglycemia suppressed by ICI treatment. Orthopedic trauma was applied to both hindlimbs in LZ and OZ rats. Fasting plasma glucose was then monitored for 6 h with or without ICI (0.2 mg·kg Ϫ1 ·h Ϫ1 iv.) treatment. One day after trauma, plasma IL-6 levels, lung neutrophil numbers, myeloperoxidase (MPO) activity, and wetto-dry weight ratios were measured. Trauma induced rapid hepatic glycogenolysis, as evidenced by decreased liver glycogen levels, and this was inhibited by ICI treatment. Compared with LZ rats, OZ rats exhibited higher posttrauma glucose, IL-6, lung neutrophil infiltration, and MPO activity. Lung wet-to-dry weight ratios were increased in OZ rats but not in LZ rats. ICI treatment reduced the early hyperglycemia, lung neutrophil retention, MPO activity, and wet-to-dry weight ratio in OZ rats to levels comparable with those seen in LZ rats, with no effect on blood pressure or heart rate. These results demonstrate that ␤ 2-adrenoreceptor blockade effectively reduces the early posttrauma hyperglycemia, which is associated with decreased lung injury in OZ rats. obesity; trauma; glucose; lung injury; ␤ 2-adrenoreceptor UNINTENTIONAL INJURIES are the leading cause of mortality in individuals under 50 yr of age in the United States, with staggering medical expenses attributable to traumatic injury (10a, 43). Obese patients with severe orthopedic trauma are at a higher risk than lean patients for increased inflammation, multiorgan failure, prolonged hospital stay, and increased mortality (5,8,10,12). Although the mechanisms responsible for the increased posttrauma complications in obese patients are unclear, intensive and specific treatments have been emphasized for these patients.Posttrauma hyperglycemia has been recognized as a risk factor that exacerbates complications, organ dysfunction, and mortality (29,41,44). Several clinical studies have suggested that, in critically ill obese patients, impaired glucose homeostasis appears to be a better predictor of increased complications and mortality than body mass index (38,41,45). In addition, there is evidence that the early hyperglycemia within the f...

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Systemic Inflammatory Response After Extremity or Truncal Fracture Operations

Cited by 46 publications

References 28 publications

Pelvic trauma: WSES classification and guidelines

Pelvic trauma: WSES classification and guidelines

Incidence and predictive risk factors of postoperative sepsis in orthopedic trauma patients

β₂-Adrenoreceptor blockade improves early posttrauma hyperglycemia and pulmonary injury in obese rats

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Systemic Inflammatory Response After Extremity or Truncal Fracture Operations

Cited by 46 publications

References 28 publications

Pelvic trauma: WSES classification and guidelines

Pelvic trauma: WSES classification and guidelines

Incidence and predictive risk factors of postoperative sepsis in orthopedic trauma patients

β2-Adrenoreceptor blockade improves early posttrauma hyperglycemia and pulmonary injury in obese rats

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β₂-Adrenoreceptor blockade improves early posttrauma hyperglycemia and pulmonary injury in obese rats