Lung complications are common in intensive care treated patients with pelvis fractures: a retrospective cohort study

Engström, Joakim; Reinius, Henrik; Ström, Jennie; Bergström, Monica; Larsson, Ing-Marie; Larsson, Anders; Borg, Tomas

doi:10.1186/s13049-016-0244-1

Cited by 9 publications

(7 citation statements)

References 22 publications

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“…Development of pulmonary complications such as pneumonia, embolism, Acute Respiratory Distress Syndrome (ARDS) and other still displays a major risk and remain major causes of long-term morbidity and mortality in trauma patients [1,2]. The mortality in case of acute lung injury in multiply traumatized patients is 10% [3,4].…”

Section: Introductionmentioning

confidence: 99%

Leukotriene B4 indicates lung injury and on-going inflammatory changes after severe trauma in a porcine long-term model

Störmann

Auner

Schimunek

et al. 2017

Prostaglandins, Leukotrienes and Essential Fatty Acids

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A B S T R A C TBackground: Recognizing patients at risk for pulmonary complications (PC) is of high clinical relevance. Migration of polymorphonuclear leukocytes (PMN) to inflammatory sites plays an important role in PC, and is tightly regulated by specific chemokines including interleukin (IL)−8 and other mediators such as leukotriene (LT)B4. Previously, we have reported that LTB4 indicated early patients at risk for PC after trauma. Here, the relevance of LTB4 to indicating lung integrity in a newly established long-term porcine severe trauma model (polytrauma, PT) was explored. Methods: Twelve pigs (3 months old, 30 ± 5 kg) underwent PT including standardized femur fracture, lung contusion, liver laceration, hemorrhagic shock, subsequent resuscitation and surgical fracture fixation. Six animals served as controls (sham). After 72 h lung damage and inflammatory changes were assessed. LTB4 was determined in plasma before the experiment, immediately after trauma, and after 2, 4, 24 or 72 h. Bronchoalveolar lavage (BAL)-fluid was collected prior and after the experiment. Results: Lung injury, local gene expression of IL-8, IL-1β, IL-10, IL-18 and PMN-infiltration into lungs increased significantly in PT compared with sham. Systemic LTB4 increased markedly in both groups 4 h after trauma. Compared with declined plasma LTB4 levels in sham, LTB4 increased further in PT after 72 h. Similar increase was observed in BAL-fluid after PT. Conclusions: In a severe trauma model, sustained changes in terms of lung injury and inflammation are determined at day 3 post-trauma. Specifically, increased LTB4 in this porcine long-term model indicated a rapid inflammatory alteration both locally and systemically. The results support the concept of LTB4 as a biomarker for PC after severe trauma and lung contusion.

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Section: Introductionmentioning

confidence: 99%

Leukotriene B4 indicates lung injury and on-going inflammatory changes after severe trauma in a porcine long-term model

Störmann

Auner

Schimunek

et al. 2017

Prostaglandins, Leukotrienes and Essential Fatty Acids

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“…On the other hand, despite a longer operative time, patients with an elevated risk of pneumonia or other pulmonary complication may benefit of immediate weight bearing with LPF. This is evidenced by the fact that pulmonary complications were common in patients with pelvic fractures [ 40 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of lumbopelvic fixation and iliosacral screw fixation for the treatment of bilateral sacral fractures

et al. 2021

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Background Bilateral sacral fractures result in traumatic disruption of the posterior pelvic ring. Treatment for unstable posterior pelvic ring fractures should aim for fracture reduction and rigid fixation to facilitate early mobilization. Iliosacral screw fixation (ISF) and lumbopelvic fixation (LPF) were recommended for the treatment of these injuries. No algorithm or gold standard exists for surgery of these fractures. Purpose The purpose of this study was to evaluate the differences between ISF and LPF in bilateral sacral fractures regarding intraoperative procedures, complications and postoperative mobilization. The secondary aim was to determine whether demographics influence surgical treatment. Methods Over a 4-year period (2016–2019), 188 consecutive patients with pelvic ring injuries were treated at one academic level 1 trauma center and retrospectively identified. Fractures were classified according to the AO/OTA classification system. Seventy-seven patients were treated with LPF or ISF in combination with internal fixation of pubic rami fractures and could be included in this study. Comparisons were made between demographic and perioperative data. Infection, hematoma and hardware malpositioning were used as complication variables. Mobilization with unrestricted weight bearing was used as outcome variable. Follow-up was at least 6 months postoperatively. Results Operative stabilization of bilateral posterior pelvic ring injuries was performed in 77 patients. Therefore, 29 patients (females 59%) underwent LPF whereas 48 patients (females 83%) had bilateral ISF. The ISF group was older (76 yrs.) compared to the LPF group (62 yrs.) (p = 0.001), but no differences regarding BMI or comorbidities were detected. Time for surgery was reduced for patients who were treated with ISF compared to lumbopelvic fixation (73 min vs. 165 min; respectively, p < 0.001). But this did not result in reduced fluoroscopic time or radiation exposure. Overall complication rate was not different between the groups. Patients with LPF had a greater length of stay (p = 0.008) but were all weight bearing as tolerated when discharged (p < 0.001). Conclusion Bilateral posterior pelvic ring injuries of the sacrum can be sufficiently treated by LPF or ISF. LPF allows immediate weight bearing which may benefit younger patients and patients with an elevated risk for pneumonia or other pulmonary complications. Treatment with ISF reduces operative time, length of stay and postoperative wound infection. Elderly patients may be better suited for treatment with ISF if there is concern that the patient may not tolerate the increased operative time.

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“…On the other hand, despite a longer operative time, patients with an elevated risk of pneumonia or other pulmonary complication may bene t of immediate weight bearing with LPF. This is evidenced by the fact that pulmonary complications were common in patients with pelvic fractures [38].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Lumbopelvic Fixation and Iliosacral Screw Fixation for the Treatment of Bilateral Sacral Fractures

Wenning

Yilmaz

Schildhauer

et al. 2021

Preprint

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Background: Bilateral sacral fractures result in traumatic disruption of the posterior pelvic ring. Treatment for unstable posterior pelvic ring fractures should aim for fracture reduction and rigid fixation to facilitate early mobilization. Iliosacral screw fixation (ISF) and lumbopelvic fixation (LPF) were recommended for the treatment of these injuries. No algorithm or gold standard exists for surgery of these fractures. Purpose: The purpose of this study was to evaluate the differences between ISF and LPF in bilateral sacral fractures regarding intraoperative procedures, complications, and postoperative mobilization. The secondary aim was to determine if demographics influence surgical treatment.Methods: Over a 4-year period (2016-2019) 188 consecutive patients with pelvic ring injuries were treated at one academic level-1 trauma center and retrospectively identified. Fractures were classified according to the AO/OTA classification system. 77 patients were treated with LPF or ISF in combination with internal fixation of pubic rami fractures and could be included in this study. Comparisons were made between demographic and perioperative data. Infection, hematoma, and hardware malpositioning were used as complication variables. Mobilization with unrestricted weight-bearing was used as outcome variable. Follow-up was at least 6 months postoperatively.Results: Operative stabilization of bilateral posterior pelvic ring injuries was performed in 77 patients. Thereof, 29 patients (females 59%) underwent LPF whereas 48 patients (females 83%) had bilateral ISF. The ISF group was older (76 yrs.) compared to the LPF group (62 yrs.) (p=0.001), but no differences regarding BMI or comorbidities were detected. Time for surgery was reduced for patients who were treated with ISF compared to lumbopelvic fixation (165 min vs. 73 min; respectively, p<0.001). But this did not result in reduced fluoroscopic time or radiation exposure. Overall complication rate was not different between the groups. Patients with LPF had a greater length of stay (p=0.008) but were all weight-bearing as tolerated when discharged (p<0.001). Conclusion: Bilateral posterior pelvic ring injuries of the sacrum can be sufficiently treated by LPF or ISF. LPF allows immediate weight-bearing which may benefit younger patients and patients with an elevated risk for pneumonia or other pulmonary complications. Treatment with ISF reduces operative time, length of stay and postoperative wound infection. Elderly patients may be better suited for treatment with ISF if there is concern that the patient may not tolerate the increased operative time.

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Lung complications are common in intensive care treated patients with pelvis fractures: a retrospective cohort study

Cited by 9 publications

References 22 publications

Leukotriene B4 indicates lung injury and on-going inflammatory changes after severe trauma in a porcine long-term model

Leukotriene B4 indicates lung injury and on-going inflammatory changes after severe trauma in a porcine long-term model

Comparison of lumbopelvic fixation and iliosacral screw fixation for the treatment of bilateral sacral fractures

Comparison of Lumbopelvic Fixation and Iliosacral Screw Fixation for the Treatment of Bilateral Sacral Fractures

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