Changes in the Management of Femoral Shaft Fractures in Polytrauma Patients: From Early Total Care to Damage Control Orthopedic Surgery

Pape, Hans‐Christoph; Hildebrand, Frank; Pertschy, Stephanie; Zelle, Boris A.; Garapati, Rayeed; Grimme, Kai; Krettek, Christian

doi:10.1097/00005373-200209000-00010

Cited by 314 publications

(90 citation statements)

References 48 publications

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“…), presence of open fractures and soft tissue contamination, surgical strategy chosen (DCO (Damage Control Orthopedics) versus ETC. (Early Total Care)), and treatment in the ICU [6, 30–32]. These parameters could not be determined and evaluated in this study.…”

Section: Discussionmentioning

confidence: 99%

Trends in intubation rates and durations in ventilated severely injured trauma patients: an analysis from the TraumaRegister DGU®

et al. 2016

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BackgroundEndotracheal intubation in severely injured patients is known to be a risk factor for systemic complications. We aimed to examine the changes in intubation rates and durations in severely injured trauma patients, and rates of the systemic complications associated with ventilation changes by using a large trauma registry over the period of 13 years.MethodsPatient demographics, Injury Severity Score (ISS), ventilation days, ventilation free days (VFD), and prevalence of systemic complications (sepsis and multiple organ failure (MOF)) were obtained from the TraumaRegister DGU® and were compared over the study period.ResultsDuring the study period (2002 – 2014), 35,232 patients were recorded in TraumaRegister DGU®. 72.7 % of patients (n = 25,629) were intubated, and 27.3 % (n = 9603) of patients did not require mechanical ventilation throughout their hospital stay. The mean age was 48 ± 21 years, mean ISS was 27.9 ± 11.5, mean length of ICU stay was 11.7 ± 13.8 days, mean time on mechanical ventilator was 7.1 ± 11.3 days, and mean ventilation free days (spontaneous respiration) was 19.5 ± 11.9 days. We observed a reduction in the intubation rates (87.5 % in 2002 versus 63.6 % in 2014), and early extubation (10 ventilation days in 2002, and 5.9 days in 2014) over time.ConclusionOur study reveals a reduction in intubation rates and ventilation duration during the observation period. Moreover, we were able to observe decreased incidence of systemic complications such as sepsis over the 13 year study period, while no changes in incidence of MOF were registered. The exact relationship can not be proven in our study. This needs to be addressed in further analysis.

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Section: Discussionmentioning

confidence: 99%

Trends in intubation rates and durations in ventilated severely injured trauma patients: an analysis from the TraumaRegister DGU®

et al. 2016

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Section: Orthopedic Surgeon Perspectivementioning

confidence: 99%

“…[2728] For many years, the concept of “early total care” was employed with early, emergent stabilization of all long bone fractures. [2829] The concept of “damage-control” arose from the observation that in the subgroup of patients with multiple injuries and/or thoracic trauma, early fixation was associated with a higher rate of complications and mortality. In this group of patients at the high risk of complications, the approach is for early temporary stabilization (controlling hemorrhage, managing soft tissue injury, and often external fixation of long bone fractures) followed by delayed definitive fixation after the risk of systemic complications decreases and overall physiologic picture improves.…”

Section: Orthopedic Surgeon Perspectivementioning

confidence: 99%

“…In this group of patients at the high risk of complications, the approach is for early temporary stabilization (controlling hemorrhage, managing soft tissue injury, and often external fixation of long bone fractures) followed by delayed definitive fixation after the risk of systemic complications decreases and overall physiologic picture improves. [28] The goal is to avoid a “second hit” and thus worsening of the patient's overall condition. Identifying patients who may benefit the most from the switch from “early total care” to “damage control” requires open communication and multidisciplinary approach.…”

Section: Orthopedic Surgeon Perspectivementioning

confidence: 99%

“…[28] Stable patients can be treated with immediate fixation, and unstable/in extremis patients should be treated with damage control. The borderline patient is the most difficult one to define and identify, but also exemplifies the situation in which the decision regarding the optimal course of action is most critical and the consequences of the “incorrect” decision are profound.…”

Section: Orthopedic Surgeon Perspectivementioning

confidence: 99%

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The right team at the right time – Multidisciplinary approach to multi-trauma patient with orthopedic injuries

Bach

Leskovan

Scharschmidt

et al. 2017

Int J Crit Illn Inj Sci

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Integrated, multidisciplinary team approach to the multiply injured patient can help optimize care, minimize morbidity, and reduce mortality. It also provides a framework for accelerated postinjury rehabilitation course. The characteristics and potential benefits of this approach, including team dynamics and interactions, are discussed in this brief review. Emphasis is placed on synergies provided by specialty teams working together in the framework of care coordination, timing of surgical and nonsurgical interventions, and injury/physiologic considerations.Republished with permission from:Bach JA, Leskovan JJ, Scharschmidt T, Boulger C, Papadimos TJ, Russell S, Bahner DP, Stawicki SPA. Multidisciplinary approach to multi-trauma patient with orthopedic injuries: the right team at the right time. OPUS 12 Scientist 2012;6(1):6-10.

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Femoral Shaft Fractures

Papakostidis

Giannoudis

2011

Evidence‐Based Orthopedics

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Changes in the Management of Femoral Shaft Fractures in Polytrauma Patients: From Early Total Care to Damage Control Orthopedic Surgery

Cited by 314 publications

References 48 publications

Trends in intubation rates and durations in ventilated severely injured trauma patients: an analysis from the TraumaRegister DGU®

Trends in intubation rates and durations in ventilated severely injured trauma patients: an analysis from the TraumaRegister DGU®

The right team at the right time – Multidisciplinary approach to multi-trauma patient with orthopedic injuries

Femoral Shaft Fractures

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