Timing Of Surgery For Fractures Research Articles

Timing of osteosynthesis of fractures in children changes the outcome.

The search for optimal treatment strategies for fractures in children that require osteosynthesis is controversial and is still being debated. A major factor that has been under discussion is the impact of the timing of surgery: the time delay between the trauma and the operation, as well as the duration of the surgical procedure, and the time of day that the operation is performed are potential factors that might influence the outcome. Therefore, the aim of our study was to investigate the influence of these factors on the outcome after osteosynthesis of diverse fractures of the extremities in children. In a retrospective study, 387 patients aged 1-18years who presented with fractures of the extremities that underwent surgery were included. Patient records including radiological studies were analyzed. The follow up period lasted at least 12months or until recovery. Statistical significance was set at an alpha level of P ≤ 0.05. Delayed surgery, as well as a prolonged duration of surgery, and the mode of transportation of the patient significantly were related to a higher rate of complications. However, in this study, the complication rate was not found to be influenced by the mode of reduction of the fracture, or the time of day or the day of the week. A further parameter that significantly changed the outcome was the mechanism of injury. However, the rate of complications was unchanged if a resident or a consulting was the performing surgeon so that a resident can safely perform the procedure in the presence of a consultant. Timing of surgery for fractures of the extremities in children, including the time from trauma to surgery, the duration of the operation and the mode of transportation to the ER, were found to have a significant impact on the occurrence of complications in this study while the mode of reduction and the time of day did not change the outcome. Future studies with a focus on selected types of fractures are needed to further enlighten this topic. Retrospective comparative study, level III.

Participants and Non-participants in the Scand-Ankle Study - An alcohol cessation intervention at the time of fracture surgery

Background Clinical experience indicates that patients declining participation in randomised clinical trials (RCTs) at the time of surgery are older, less healthy and of lower social status than patients accepting to participate, compromising the external validity of the RCT and bringing the non-participants in higher risk at surgery. To our knowledge, no studies exist on patients with hazardous alcohol consumption who decline participation in RCTs at the time of surgery. The aim was to compare characteristics of the participants and non-participants in the Scand-Ankle RCT. Method The Scand-Ankle study is a RCT that investigates the effect of a 6-week gold standard alcohol intervention (GSP-A) on postoperative complications in patients drinking >21 units/week and undergoing ankle fracture surgery. This study included eligible patients that declined to participate in the Scand-Ankle RCT but gave informed consent to follow-up in their medical record (N=67). Their perioperative patient characteristics were obtained from their medical record and the characteristics were compared to the patients enrolled in the study so far (N=61). Results The baseline characteristics showed no differences between participants and non-participants, but some tendencies towards the non-participants being older, having severak co-morbidities and higher ASA scores. None of the variables of interest in relation to postoperative complications (age over 70 years, comorbidity, daily smoking, ASA scores, fracture type, BMI, alcohol) were significant predictors for non-participation. Conclusion No differences were found between participants and non-participants and no patient characteristics could significantly predict participation. (Less)