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Do Parameters Used to Clear Noncritically Injured Polytrauma Patients for Extremity Surgery Predict Complications?

  • Symposium: Tscherne Festschrift
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

In multiply injured patients, definitive stabilization of major fractures is performed whenever feasible, depending on the clinical condition.

Questions/purposes

We therefore asked whether (1) any preoperative indicators predict major complications after major extremity surgery; (2) perioperative routine parameters other than those indicative of hemorrhagic shock predict postoperative complications; and (3) any postoperative clinical findings can predict major complications in the further course of the patient.

Methods

We prospectively followed patients with femoral midshaft fracture, Injury Severity Score (ISS) > 16 points, or three fractures and Abbreviated Injury Scale (AIS) ≥ 2 points and another injury (AIS ≥ 2 points), and age 18 to 65 years. We recorded multiple clinical parameters. End points were pneumonia, sepsis, acute respiratory distress syndrome, acute lung injury, and multiple organ failure.

Results

Forty-three of 165 patients developed complications. (1) Patients with complications had a decreased initial Glasgow Coma Scale and tended to have a lower ISS. (2) None of the assessed perioperative parameters was able to sufficiently predict postoperative complications. (3) The presence of a lung contusion and ventilation > 48 hours were associated with complications in the further course.

Conclusions

In stable multiply injured patients, none of the individual routine clinical parameters was able to predict complications. Severe head and thoracic injuries seem to be important drivers for the development postoperative complications.

Level of Evidence

Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Trauma, University of Aachen Medical Center, Aachen, Germany

    Thomas Dienstknecht MD & Hans-Christoph Pape MD

  2. Trauma Hospital, Duisburg, Germany

    Dieter Rixen MD

  3. Academic Department of Trauma & Orthopaedics, School of Medicine, Leeds Teaching Hospitals, University of Leeds, Leeds, UK

    Peter Giannoudis MD

  4. Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Hans-Christoph Pape MD

Authors
  1. Thomas Dienstknecht MD
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  2. Dieter Rixen MD
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  3. Peter Giannoudis MD
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  4. Hans-Christoph Pape MD
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Consortia

the EPOFF Study Group

Corresponding author

Correspondence to Hans-Christoph Pape MD.

Additional information

The members of the EPOFF (European Polytrauma study on the Management of Femur Fractures) Study Group are as follows:

A. Gruner MD, Department of Trauma, Braunschweig, Germany

H. J. Oestern MD, Department of Trauma, Celle, Germany

C. Dumont MD, Department of Trauma, Goettingen, Germany

M. Mueller MD, Department of Trauma, Kiel, Germany

B. Bouillon MD, Department of Trauma, Cologne, Germany

D. Rixen MD, Department of Trauma, Duisburg, Germany

J. Morley MD, Department of Trauma, Leeds, UK

St. Ruchholtz MD, Department of Trauma, Marburg, Germany

E. Ellingsen MD, Oslo, Norway

G. Regel MD, Rosenheim, Germany

M. McClinsey MD, Department of Orthopaedics, Pittsburgh, PA, USA

This study has been supported by AO/ASIF (grant no. AO/ASIF 99 P65 [H-CP]).

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Dienstknecht, T., Rixen, D., Giannoudis, P. et al. Do Parameters Used to Clear Noncritically Injured Polytrauma Patients for Extremity Surgery Predict Complications?. Clin Orthop Relat Res 471, 2878–2884 (2013). https://doi.org/10.1007/s11999-013-2924-8

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  • DOI: https://doi.org/10.1007/s11999-013-2924-8

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