Yannik Kalbas (Zurich / CH), Felix Karl-Ludwig Klingebiel (Zurich / CH), Yannik Stutz (Zurich / CH), Sascha Halvachizadeh (Zurich / CH), Michel Paul Johan Teuben (Zurich / CH), Kai Oliver Jensen (Zurich / CH), Markus Florian Oertel (Zurich / CH), Hans-Christoph Pape (Zurich / CH), Roman Pfeifer (Zurich / CH), Christian Thomas Hübner (Zurich / CH)
Introduction: Timing of major fracture fixation remains one of the most actively discussed topics in polytrauma research. Besides physiologic factors, associated injuries, and injury patterns also require consideration. The exact impact and relevance of traumatic brain injury on the timing of fracture care have not yet been fully investigated.
Methods: All polytrauma patients at a level one trauma center from 2015 to 2020 were screened. Patients with an ISS >16 and at least one body region requiring operative fixation were included. Patients who underwent their first definitive surgery <24h were stratified as group SDS (Safe Definitive Surgery) and >24h as group DFC (Delayed Fracture Care). Outcomes were mortality (<72h), SIRS/sepsis, timing to first/final definitive surgery, total number of surgeries, and factors influencing the surgical strategy (e.g., unstable physiology). Odds ratios for treatment strategies and influencing factors were calculated using Fisher`s exact test.
Results: From 901 patients screened, 239 were included (Group DFC: 151, Groups SDS: 88). Groups did not significantly differ regarding early mortality, SIRS and sepsis. Group SDS had significantly fewer operations (4.3 vs. 5.3; p=0.037) and significantly earlier completion of full reconstruction (10 days vs. 15 days; p=0.013). Unstable physiology and intracranial trauma sequelae with the necessity for neurosurgical interventions (NSI) were identified as most significant factors for delaying definitive fracture care (OR: 2.85; p<0.001 and OR: 5.59; p=0.002). The presence of intracranial bleeding (IB) without NSI did not have a significant influence (OR: 1.21; p=0.652).
Conclusion: The necessity of NSI and unstable physiology are highly relevant factors for delaying definitive fracture care in polytrauma patients. The presence of IB without NSI had less impact. Early definitive fracture care in physiologically stable patients without NSI, was not associated with increased patient morbidity.
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