Thurs., 10/16/08 Tibia/Polytrauma, Paper #12, 4:27 pm OTA-2008
Δ Early Definitive Stabilization of Unstable Pelvis and Acetabulum Fractures Reduces Morbidity
Heather A. Vallier, MD (a-OTA Research Grant, Synthes); F. Parke Oldenburg, MD (n);
Charles Ekstein (n); Beth Ann Cureton, BS (n);
MetroHealth Medical Center, Cleveland, Ohio, USA
Purpose: Although the benefits of acute stabilization of long-bone fractures are recognized, the role of early fixation of unstable pelvis and acetabular fractures is not well defined. The purpose of this study was to review complications and hospital course of patients treated surgically for pelvis and acetabulum fractures. We hypothesized that early definitive fixation would reduce morbidity and decrease length of stay.
Methods: We performed a retrospective review of 227 patients treated surgically at a Level 1 trauma center for unstable fractures of the pelvic ring (n = 81), acetabulum (n = 133), or both (n = 13). Mean age was 43.3 years and mean Injury Severity Score (ISS) was 19.2 (range, 9-66). Fracture classification, transfusion requirements, length of mechanical ventilation, and ICU and hospital length of stay were determined. Complications included acute respiratory distress syndrome (ARDS), pneumonia, deep vein thrombosis, pulmonary embolism, multiple organ failure (MOF), infections, and reoperations.
Results: Definitive fixation was within 24 hours of injury in 79 patients (early, mean 11.4 hour) and greater than 24 hours in 148 (late, mean 80.9 hours). 19 patients had complications after early fixation versus 54 after late (P = 0.034). Considering those with ISS >18 (n = 39 early [ISS 25.7]; n = 64 late [ISS 27.6]), early fixation resulted in fewer pulmonary complications (12.8% vs 50%, P = 0.0001), less ARDS (10.3% vs 35.9%, P = 0.0051), and less MOF (2.6% vs 15.6%, P = 0.049). In patients receiving ≥10 U packed red blood cells (n = 12 early, n = 16 late) early fixation led to fewer pulmonary complications (25% vs 87.5%, P = 0.0015), less ARDS (25% vs 81.3%, P = 0.0061), and no MOF (vs 50%). Chest injury (Abbreviated Injury Scale [AIS] ≥3) was present in 12.7% of early and 20.9% of late patients (P = 0.15), and was associated with pulmonary complications in 20% vs 38.7%, ARDS in 10% vs 25.8%, and MOF in 0 vs 16.1%, respectively (all P >0.21). Early treatment was associated with shorter mean ICU stay (90 vs 154 hours, P = 0.024) and hospitalization (227 vs 320 hours, P = 0.0023).
Conclusion and Significance: Early fixation of unstable pelvis and acetabular fractures in multiply injured patients reduces morbidity and length of hospitalization, which may decrease treatment costs. Further study to ascertain the effects of associated systemic injuries and the utility of physiologic and laboratory parameters during resuscitation may delineate recommendations for optimal surgical timing in specific patient groups.
If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.