Time to definitive fixation of pelvic and acetabular fractures

Abstract

BACKGROUND The timing of definitive surgical stabilization is a controversial topic of pelvic and acetabular fracture (PAF) management. Historically, staged care with delayed definitive fixation was recommended; however, more recently, some centers have shown early definitive fixation to be feasible in most patients. We hypothesized that time to definitive fixation of PAF decreased without adverse outcomes. METHODS A level 1 trauma center's prospective pelvic fracture database was retrospectively analyzed. A total of 341 of the 1,270 consecutive PAF patients had surgery between January 2009 and December 2018. Demographics, polytrauma status, hemodynamic stability, time to definitive operation, length of intensive care unit stay, hospital length of stay, mortality were recorded. Data is presented as mean ± SD, percentages. Statistical significance was determined at p < 0.05. RESULTS There were 34 ± 8 per year operatively treated PAF patients during the study period. The demographics (age, 44.1 ± 18 years; 74.5% males) and injury severity (Injury Severity Score, 20; interquartile range, 16–29) did not change. Time to definitive fixation on average was 85 ± 113 hours (range, 0.8–1286 hours). Linear regression analysis demonstrated a decrease in time to definitive fixation considering all patients ( β = −0.186, p = 0.003). pelvic ring fractures with polytrauma ( β = −1.404, p = 0.03). and hemodynamically unstable patients ( β = −1.428, p = 0.037). There was no significant change in mortality, length of stay, or intensive care unit length of stay for the overall cohort or any subgroup. CONCLUSION Time to definitive fixation in PAF has decreased during the last decade, with the largest decrease in time to fixation occurring in the hemodynamically unstable and pelvic fracture with polytrauma cohorts. The timely definitive internal fixation is achievable without increased length of stay. LEVEL OF EVIDENCE Therapeutic/care management, level IV.

Factors associated with mortality in older patients sustaining pelvic or acetabular fractures

“…Across the age spectrum, no association has been demonstrated between time to PA surgery and mortality [ 19 ]. To the best of our knowledge, a recent study by Glogovac et al [ 20 ] is the only paper that investigates the relationship between time to surgery and mortality rates in geriatric patients with acetabular fractures; pelvic fractures were not included.…”

Management of pelvic injuries in hemodynamically unstable polytrauma patients – Challenges and current updates

“…81 Traditionally, definitive fixation of pelvic fractures was suggested beyond 72 h. However, there is increasing evidence which shows the feasibility of safely performing definitive surgery within this timeframe, which is associated with a very low mortality rate of 2.3%. 82 However, the time-taken for definitive management of these unstable fracture fixations in an acute setting, and their implications have been less studied. Early Appropriate Care (EAC) involves definitive fixation (within 36 h) for unstable fractures of the thoracolumbar spine, pelvis, acetabulum, and/or femur following achievement of definitive thresholds of physiological parameters.…”

Definitive fixation of pelvic and acetabular fractures – current concepts

“…Devaney et al revealed in there study based on analysis of 341 patients that between january 2009 and December 2018 time to definitive surgery decreased from 116 to 54 hours without increase of complications and mortality rate [9].…”