Ivan Sivriev (Zurich / CH), Felix Karl-Ludwig Klingebiel (Zurich / CH), Yannik Kalbas (Zurich / CH), Michel Paul Johan Teuben (Zurich / CH), Hans-Christoph Pape (Zurich / CH), Roman Pfeifer (Zurich / CH)
Introduction
Temporary external fixation is an established procedure in damage control surgery to adapt to the patient`s physiology. Yet, external fixation is also performed in patients that could also be cleared for early definitive fixation. MUST (MusculoSkeletal Temporary Surgery) describes injury patterns that should be considered for temporary fixation also in isolated musculoskeletal injuries. The impetus of our study was to identify patient characteristics that are predictive for external fixation in physiologically compensated patients.
Material & Methods
A retrospective database of patients admitted via trauma bay followed by surgical treatment from 2015 -2022 was analyzed. Only physiological compensated patients were included for further analysis. Statistical comparison was performed to test for significant differences in between the groups and logistic regression was performed to identify independent predictive factors for external fixation. Subgroup analysis for patients with and without cerebral injuries was performed.
Results
From 355 initial patients, 204 patients were considered as physiological compensated. 78 patients received temporary external fixation and 126 did not. Patients in the external fixation group presented significant more open fractures, a higher ISS and AIS of the lower extremities. Adjusted logistic regression yielded the presence open fractures, elevated AIS of the lower extremities, non-intra-articular fractures and presence of cerebral injuries as independent predictors for external fixation.
Conclusion
The presence of intracranial injuries seems to influence the surgical decision making towards external fixation regardless of the injury severity and morphology. In addition, an open fracture constellation as well as the severity of lower extremity injuries seem to be able to predict external fixation. Further research regarding (temporary) fracture fixation within patients with intracranial lesions should be undertaken.
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