DOES THE TERM OF DEFINITIVE OSTEOSYNTHESIS OF MULTIPLE LONG BONE FRACTURES OF LOWER EXTREMITIES IMPACT ON TREATMENT OUTCOMES IN POLYTRAUMA PATIENTS

Olexandr Burianov,Viktor Lykhodii,Sergii Dubrov,Volodymyr Lianskorunskyi,Myroslav Vakulych,Taras Omelchenko

doi:10.21303/2504-5679.2020.001332

Olexandr Burianov, Viktor Lykhodii + Show 4 more

Open Access

https://doi.org/10.21303/2504-5679.2020.001332

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Abstract

The aim: to determine the timing impact of definitive multiple long bone fracture osteosynthesis of lower extremities on complications development, duration of Mechanical Ventilation (MV), Length of Stay in Intensive Care Unit (LOS-ICU), Hospital length of Stay (H-LOS) in patients with polytrauma treated according to Damage Control Orthopedics (DCO). Materials and methods: a prospective controlled non-randomized trial in parallel groups conducted in polytrauma department of Kyiv City Clinical Hospital No. 17 from February 2016 to January 2020, which included 107 adult patients with polytrauma, multiple long bone fractures of lower extremities, one of which femur treated according to DCO. The patients were divided into two groups: Group I included 51 patients who underwent definitive osteosynthesis of long bone fractures of lower extremities after patient condition stabilization ≥24 hours ≤5 days; Group II included 56 patients who underwent definitive osteosynthesis of long bone fractures of lower extremities during the period >5 days after injury. Results: there were no statistically significant differences between Group I and Group II patients in demographics, injury mechanism, trauma severity and general patient condition. Group I patients who underwent osteosynthesis from 2nd to 5th days after injury had lower pneumonia incidence, compared to Group II patients (17.6 % vs. 26.8 %, p=0.047), shorter MV duration (9.3±6.9 vs. 14.9±9.1, p=0.048), ICU-LOS (13.5±8.3 vs. 19.1±11.0, p=0.037), and H-LOS (30.3±13.9 vs. 38.9±15.5, p=0.046). Conclusion: performing definitive multiple fracture osteosynthesis of lower extremity long bones after polytrauma patient stabilization from 2nd to 5th days after injury allowed to reduce the frequency of pneumonia, shorten the duration of MV, LOS-ICU and H-LOS, compared with its implementation after 5th days

Highlights

Lower extremities injuries are common in patients with polytrauma [1, 2]
The aim: to determine the timing impact of definitive multiple long bone fracture osteosynthesis of lower extremities on complications development, duration of Mechanical Ventilation (MV), Length of Stay in Intensive Care Unit (LOS-ICU), Hospital length of Stay (H-LOS) in patients with polytrauma treated according to Damage Control Orthopedics (DCO)
Materials and methods: a prospective controlled non-randomized trial in parallel groups conducted in polytrauma department of Kyiv City Clinical Hospital No 17 from February 2016 to January 2020, which included 107 adult patients with polytrauma, multiple long bone fractures of lower extremities, one of which femur treated according to DCO

Summary

Introduction

Lower extremities injuries are common in patients with polytrauma [1, 2]. Long bone fractures, especially of femur, are associated with development of numerous complications, including Acute Respiratory Distress Syndrome (ARDS), fat embolism, pneumonia, sepsis, Multiple Organ Failure (MOF) and death [3, 4].Patients with injuries of two or more segments, presented with bilateral, ipsilateral and contralateral fractures of femur and tibia, have increased risk of complications, compared with a fracture of one long bone and these patients need special care management [5, 6].The choice of timing and method of lower extremity bone fracture fixation in patients with polytrauma is a controversial question [7, 8]. Patients with injuries of two or more segments, presented with bilateral, ipsilateral and contralateral fractures of femur and tibia, have increased risk of complications, compared with a fracture of one long bone and these patients need special care management [5, 6]. The literature presents many studies confirming the benefits of early definitive osteosynthesis within ≤24 hours in patients with polytrauma according to Early Total Care (ETC), but these patients are in stable clinical condition and have a fracture of one long bone of lower extremity [9, 10]. The use of ETC tactics is possible in patients with multiple long bone fractures of lower extremities, but most researchers prefer using Damage Control Orthopedics (DCO) [11, 12]

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