Abstract
PurposeTreatment strategies for femoral fracture stabilisation are well known to have a significant impact on the patient’s outcome. Therefore, the optimal choices for both the type of initial fracture stabilisation (external fixation/EF, early total care/ETC, conservative treatment/TC) and the best time point for conversion from temporary to definitive fixation are challenging factors.PatientsPatients aged ≥ 16 years with moderate and severe trauma documented in the TraumaRegister DGU® between 2002 and 2018 were retrospectively analysed. Demographics, ISS, surgical treatment strategy (ETC vs. EF vs. TC), time for conversion to definitive care, complication (MOF, sepsis) and survival rates were analysed.ResultsIn total, 13,091 trauma patients were included. EF patients more often sustained high-energy trauma (car: 43.1 vs. 29.5%, p < 0.001), were younger (40.6 vs. 48.1 years, p < 0.001), were more severely injured (ISS 25.4 vs. 19.1 pts., p < 0.001), and had higher sepsis (11.8 vs. 5.4%, p < 0.001) and MOF rates (33.1 vs. 16.0%, p < 0.001) compared to ETC patients. A shift from ETC to EF was observed. The time until conversion decreased for femoral fractures from 9 to 8 days within the observation period. Sepsis incidences decreased in EF (20.3 to 12.3%, p < 0.001) and ETC (9.1–4.8%, p < 0.001) patients.ConclusionsOur results show the changes in the surgical treatment of severely injured patients with femur fractures over a period of almost two decades caused by the introduction of modern surgical strategies (e.g., Safe Definitive Surgery). It remains unclear which subgroups of trauma patients benefit most from these strategies.
Highlights
Materials and methodsThe surgical treatment for severely injured patients has undergone extensive development over the past 20 years
As a bridging strategy, Scalea et al published an early fixation of femur fractures with external fixators (EF) to avoid the burden of an early total care (ETC), thereby reducing complications, blood loss and mortality rates after major trauma [1]
The patients predominantly suffered from blunt trauma (97.2%)
Summary
Materials and methodsThe surgical treatment for severely injured patients has undergone extensive development over the past 20 years. Until the introduction of the damage control orthopaedics concept (DCO) by Scalea et al in 2000, the early definitive care for these patients has been performed for over four decades. It has been observed that early definitive care leads to increased mortality rates in some subgroups of severely injured patients (e.g., unstable patients or patients with thoracic trauma). A recent comparison of the four most common scoring systems has revealed that the Polytrauma Grading Score (PTGS) appears to be the most accurate [2]. In a comparison of the four scoring systems, the PTGS proved to be the most reliable predictor of complications, while the lactate concentration showed a higher predictive value with regard to 72-h mortality. Lactate concentrations are only of limited use in the presence of a liver injury, since this injury has a direct influence on lactate clearance and lactate accumulation can, occur [3]
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