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Functional Long-Term Outcomes in Polytrauma Patients with Orthopedic Injuries

  • Chapter
Damage Control Management in the Polytrauma Patient

Outcome research is the process of data collection, analysis, and interpretation of the efficiency and effectiveness of patient treatment [1]. The purpose of outcome research is to improve the quality of patient care, and clinical outcome research should be an integral component of orthopedic research. For several reasons, thorough outcome evaluations in polytrauma patients provide important data for physicians, physical and occupational therapists, as well as for insurance and hospital administrations:

  • A detailed analysis of the long-term results following polytrauma provides important information for the development or improvement of treatment guidelines and the allocation of resources.

  • A broad knowledge of long-term outcomes following polytrauma will help the trauma surgeons and therapists to better manage and advise their patients regarding discharge planning, rehabilitation plans, or career planning, and the patients may benefit from a more thorough consultation.

  • With increased health-care costs, the length of rehabilitation, the length of physical disability, and employment status following polytrauma are of economical interest.

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References

  1. Dobrzykowski EA. The methodology of outcomes measurement. J Rehabil Outcomes 1997; 1:8–17

    Google Scholar 

  2. Kinzl L, Gebhard F, Arand M. Polytrauma and economics. Unfallchirurgie 1996; 22:179–185

    CAS  PubMed  Google Scholar 

  3. Regel G, Lobenhoffer P, Grotz M, Pape HC, Lehmann U, Tscherne H. Treatment results of patients with multiple trauma: An analysis of 3406 cases treated between 1972 and 1991 at a German Level I Trauma Center. J Trauma 1995; 38:70–78

    Article  CAS  PubMed  Google Scholar 

  4. Tegner Y, Lysholm J, Odensten M, Gillquist J. Evaluation of cruciate ligament injuries: A review. Acta Orthop Scand 1988; 59:336–341

    Article  CAS  PubMed  Google Scholar 

  5. Ware JE Jr. Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992; 30:473–483

    Article  PubMed  Google Scholar 

  6. Bergner M, Bobbitt RA, Carter WB, Gilson BS. The Sickness Impact Profile: Development and final revision of a health status measure. Med Care 1981; 19:787–805

    Article  CAS  PubMed  Google Scholar 

  7. Pirente N, Bouillon B, Schafer B, Raum M, Helling HJ, Berger E, Neugebauer E. Systematic development of a scale for determination of health-related quality of life in multiple trauma patients. The Polytrauma Outcome (POLO) Chart. Unfallchirurg 2002; 105:413–422

    Google Scholar 

  8. Swiontkowski MF, Engelberg R, Martin DP, Agel J. Short musculoskeletal function assessment questionnaire: Validity, reliability, and responsiveness. J Bone Joint Surg Am 1999; 81:1245–1260

    Google Scholar 

  9. Guyatt GH, Feeny DH, Patrick DL. Measuring health-related quality of life. Ann Int Med 1993; 118:622–629

    CAS  PubMed  Google Scholar 

  10. McSweeny AJ, Creer TL: Health related quality-of-life assessment in medical care. Dis Month 1995; 41:6–71

    Article  Google Scholar 

  11. Zelle B, Stalp M, Weihs C, Müller F, Reiter FO, Krettek Ch, Pape HC. Arbeitsgemeinschaft “Polytrauma” der Deutschen Gesellschaft für Unfallchirurgie. Validation of the Hannover Score for Polytrauma Outcome (HASPOC) in a sample of 170 polytrauma patients and a comparison with the SF-12. Chirurg 2003; 74:361–369

    Article  CAS  PubMed  Google Scholar 

  12. Tscherne H, Oestern HJ, Sturm JA. Stress tolerance of patients with multiple injuries and its significance for operative care. Langenbeck Arch Chir 1984; 364:71–77

    Article  CAS  Google Scholar 

  13. Frink M, Probst C, Hildebrand F, Richter M, Hausmanninger C, Wiese B, Krettek C, Pape H-C, AG Polytrauma der DGU. The influence of transportation mode on mortality in polytraumatized patients: An analysis based on the German Trauma Registry. Unfallchirurg 2007; 110:334–340

    Article  CAS  PubMed  Google Scholar 

  14. Gomberg BF, Gruen GS, Smith WR, Spott M. Outcomes in acute orthopaedic trauma: A review of 130,506 patients by age. Injury 1999; 30:431–437

    Article  CAS  PubMed  Google Scholar 

  15. Hildebrand F, Giannoudis PV, Griensven M, Zelle B, Ulmer B, Krettek C, Bellamy MC, Pape HC. Management of polytraumatized patients with associated blunt chest trauma: A comparison of two European countries. Injury 2005; 36:293–302

    Article  PubMed  Google Scholar 

  16. Matthes G, Seifert J, Bogatzki S, Steinhage K, Ekkernkamp A, Stengel D. Age and survival likelihood of polytrauma patients. Local tailoring of the DGU prognosis model. Unfallchirurg 2005; 108:288–292

    Article  CAS  PubMed  Google Scholar 

  17. Pape HC, Hildebrand F, Pertschy S, Zelle B, Garapati R, Grimme K, Krettek C, Reed RL 2nd. Changes in the management of femoral shaft fractures in polytrauma patients: From early total care to damage control orthopedic surgery. J Trauma 2002; 53:452–462

    Article  PubMed  Google Scholar 

  18. Pape HC, Giannoudis PV, Krettek C. The timing of fracture treatment in polytrauma patients: Relevance of damage control orthopedic surgery. Am J Surg 2002; 183:622–629

    Article  PubMed  Google Scholar 

  19. Renne J, Wuthier R, House E, Cancro JC, Hoaglund FT. Fat macroglobulemia caused by fractures or total hip replacement. J Bone Joint Surg Am 1978; 60-A:613–618

    Google Scholar 

  20. Bone LB, Johnson KD, Weigelt J, Scheinberg R. Early versus delayed stabilisation of femoral fractures: A prospective randomized study. J Bone Joint Surg Am 1989; 71-A:336–340

    Google Scholar 

  21. Bone LB, McNamara K, Shine B, Border J. Mortality in multiple trauma patients with fractures. J Trauma 1994; 37:262–264

    Article  CAS  PubMed  Google Scholar 

  22. Goris RJ, Gimbrere JS, van Niekerk JL, Schoots FJ, Booy LH. Early osteosynthesis and prophylactic mechanical ventilation in the multitrauma patient. J Trauma 1982; 22;895–903

    Article  CAS  PubMed  Google Scholar 

  23. Johnson KD, Cadambi A, Seibert GB. Incidence of adult respiratory distress syndrome in patients with multiple musculoskeletal injuries: Effect of early operative stabilization of fractures. J Trauma 1985; 25:375–384

    Article  CAS  PubMed  Google Scholar 

  24. Riska EB, von Bonsdorff H, Hakkinen S, Jaroma H, Kiviluoto O, Paavilainen T. Primary operative fixation of long bone fractures in patients with multiple injuries. J Trauma 1977; 17:111–121

    Article  CAS  PubMed  Google Scholar 

  25. Ecke H, Faupel L, Quoika P. Considerations on the time of surgery of femoral fractures. Unfallchirurgie 1985; 11:89–93

    Article  CAS  PubMed  Google Scholar 

  26. Pape HC, Auf’m’Kolk M, Paffrath T, Regel G, Sturm J, Tscheme H. Primary intramedullary femur fixation in multiple trauma patients with associated lung contusion – a cause of posttraumatic ARDS? J Trauma 1993; 34:540–548

    Article  CAS  PubMed  Google Scholar 

  27. Reynolds MA, Richardson JD, Spain DA, Seligson D, Wilson MA, Miller FB. Is the timing of fracture fixation important for the patient with multiple trauma? Ann Surg 1995; 222:470–481

    CAS  PubMed  Google Scholar 

  28. Rotondo MF, Schwab CW, McGonigal MD, Phillips GR, Fruchterman TM, Kauder DR, Latenser BA, Angood PA. “Damage control”: An approach for improved survival in exsanguinating penetrating abdominal injuries. J Trauma 1993; 35:375–382

    Article  CAS  PubMed  Google Scholar 

  29. Nowotarski PJ, Turen CH, Brumback RJ, Scarboro JR.Conversion of external fixation to intramedullary nailing for fractures of the shaft of the femur in multiply injured patients. J Bone Joint Surg Am 2000; 82-A:781–788

    Google Scholar 

  30. Scalea TM, Boswell SA, Scott JD, Mitchell KA, Kramer ME, Pollak AN. External fixation as a bridge to intramedullary nailing for patients with multiple injuries and with femur fractures: Damage control orthopedics. J Trauma 2000; 48:613–623

    Article  CAS  PubMed  Google Scholar 

  31. Baker SP, O’Neill B. The injury severity scores: An update. J Trauma 1976; 16:882–885

    Article  CAS  PubMed  Google Scholar 

  32. Bhandari M, Zlowodzki M, Tornetta P, Schmidt A, Templeman DC. Intramedullary nailing following external fixation in femoral and tibial shaft fractures. J Orthop Trauma 2005; 19:140–144

    Article  PubMed  Google Scholar 

  33. Anke AG, Stanghelle JK, Finset A, Roaldsen KS, Pillgram-Larsen J, Fugl-Meyer AR. Long-term prevalence of impairments and disabilities after multiple trauma. J Trauma 1997; 42:54–61

    Article  CAS  PubMed  Google Scholar 

  34. Brenneman FD, Redelmeier DA, Boulanger BR, McLellan BA, Culhane JP. Long-term outcomes in blunt trauma: Who goes back to work? J Trauma 1997; 42:778–781

    Article  CAS  PubMed  Google Scholar 

  35. Holbrook TL, Anderson JP, Sieber WJ, Browner D, Hoyt DB. Outcome after major trauma: 12-month and 18-month follow-up results from the Trauma Recovery Project. J Trauma 1999; 46:765–771

    Article  CAS  PubMed  Google Scholar 

  36. Lehmann U, Gobiet W, Regel, G, al Dhaher S, Krah B, Steinbeck K, Tscherne H. Functional. Neuropsychological and social outcome of polytrauma patients with severe craniocerebral trauma. Unfallchirurg 1997; 100:552–560

    Article  CAS  PubMed  Google Scholar 

  37. Rhodes M, Aronson J, Moerkirk G, Petrash E. Quality of life after the trauma center. J Trauma 1988; 28:931–938

    Article  CAS  PubMed  Google Scholar 

  38. Seekamp A, Regel G, Tscherne H. Rehabilitation and reintegration of multiply injured patients: An outcome study with special reference to multiple lower limb fractures. Injury 1996; 27:133–138

    Article  CAS  PubMed  Google Scholar 

  39. Seekamp A, Regel G, Bauch S, Takace J, Tscherne H. Long-term results of therapy of polytrauma patients with special reference to serial fractures of the lower extremity. Unfallchirurg 1994;97:57–63

    CAS  PubMed  Google Scholar 

  40. Bosse MJ, MacKenzie EJ, Kellam J, Burgess AR, Webb LX, Swiontkowski MF, Sanders RW, Jones AL, McAndrew MP, Patterson BM, McCarthy ML, Travison TG, Castillo RC. An analysis of outcomes of reconstruction or amputation of leg-threatening injuries. N Engl J Med 2002; 347:1924–1931

    Article  PubMed  Google Scholar 

  41. MacKenzie EJ, Bosse MJ, Castillo RC, Smith DG, Webb LX, Kellam JF, Burgess AR, Swiontkowski MF, Sanders RW, Jones AL, McAndrew MP, Patterson BM, Travison TG, McCarthy ML. Functional outcomes following lower extremity amputation for trauma. J Bone Joint Surg Am 2004; 86-A:1636–1645

    PubMed  Google Scholar 

  42. MacKenzie EJ, Bosse MJ, Pollak AN, Pollak AN, Webb LX, Swiontkowski MF, Kellam JF, Smith DG, Sanders RW, Jones AL, Starr AJ, McAndrew MP, Patterson BM, Burgess AR, Castillo RC. Long-term persistance of disability following severe lower limb trauma: Results of a seven year follow-up. J Bone Joint Surg Am 2005; 87-A:1801–1809

    Article  Google Scholar 

  43. MacKenzie EJ, Bosse MJ. Factors influencing outcome following limb-threatening lower limb trauma: Lessons learned from the lower extremity assessment project (LEAP). J Am Acad Orthop Surg 2006; 14(10 Suppl):S205–S210

    PubMed  Google Scholar 

  44. McCarthy M, MacKenzie EJ, Edwin D. Psychological distress associated with severe lower limb injury. J Bone Joint Surg Am 2003; 85:1689–1697

    PubMed  Google Scholar 

  45. Smith JJ, Agel J, Swiontkowski MF, Castillo R, MacKenzie E, Kellam JF, The LEAP Study Group. Functional outcome of bilateral limb threatening lower extremity: Injuries at two years post injury. J Orthop Trauma 2005; 19:249–253

    Article  PubMed  Google Scholar 

  46. Pape HC, Zelle B, Lohse R, Hildebrand F, Krettek C, Panzica M, Duhme N, Sittaro N. Evaluation and outcome of patients after polytrauma: Can patients be recruited for long-term follow-up? Injury 2006; 37:1197–1203

    Article  PubMed  Google Scholar 

  47. Sittaro NA, Lohse R, Panzica M, Probst C, Pape H-C, Krettek C. Hannover-polytrauma-longterm-study HPLS. Versicherungsmedizin 2007; 59:20–25

    CAS  PubMed  Google Scholar 

  48. Zelle BA, Brown SR, Panzica M, Lohse R, Sittaro N, Krettek C, Pape H-C. The impact of injuries below the knee joint on the long-term functional outcome following polytrauma. Injury 2005; 36:169–177

    Article  CAS  PubMed  Google Scholar 

  49. Zelle BA, Panzica M, Vogt MT, Sittaro N, Krettek C, Pape H-C. Influence of workers’ compensation eligibility upon functional recovery 10 to 28 years after polytrauma. Am J Surg 2005; 190:30–36

    Article  PubMed  Google Scholar 

  50. Ware JE, Kosinski M, Keller SD. A 12-item short-form-health survey: Construction of scales and preliminary tests of reliability and validity. Med Care 1996; 34:220–233

    Article  PubMed  Google Scholar 

  51. Alter HJ, Braun R, Zazzali JL. Health status disparities among public and private emergency department patients. Acad Emerg Med 1999; 6:736–743

    Article  CAS  PubMed  Google Scholar 

  52. Andresen EM, Fouts BS, Romeis JC, Brownson C. Performance of health-related quality-of-life instruments in a spinal cord injured population. Arch Phys Med Rehabil 1999; 80:877–884

    Article  CAS  PubMed  Google Scholar 

  53. Schandelmaier P, Krettek C, Rudolf J, Tscherne H. Outcome of tibial shaft fractures with severe soft tissue injury treated by unreamed nailing versus external fixation. J Trauma 1995; 39:707–711

    Article  CAS  PubMed  Google Scholar 

  54. Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 1982; 10:150–154

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopedic Surgery, University of Pittsburgh School of Medicine, Kaufmann Building, 3471 Fifth Avenue, Suite 1011, Pittsburgh, PA, 15213, USA

    Boris A. Zelle

Authors
  1. Boris A. Zelle
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  2. Andrew Marcantonio
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  3. Ivan S. Tarkin
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Corresponding author

Correspondence to Boris A. Zelle .

Editor information

Editors and Affiliations

  1. Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA

    Hans-Christoph Pape  & Andrew Peitzman  & 

  2. Department of Surgery, University of Pennsylvania School of Medicine University of Pennsylvania Medical CenterUniversity of Pittsburgh, Pittsburgh, PA, USA

    C. William Schwab

  3. Leeds General Infirmary University Hospital Trauma and Orthopedic Surgery, University of Leeds, Leeds, Yorkshire, UK

    Peter V. Giannoudis

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Zelle, B.A., Marcantonio, A., Tarkin, I.S. (2010). Functional Long-Term Outcomes in Polytrauma Patients with Orthopedic Injuries. In: Pape, HC., Peitzman, A., Schwab, C.W., Giannoudis, P.V. (eds) Damage Control Management in the Polytrauma Patient. Springer, New York, NY. https://doi.org/10.1007/978-0-387-89508-6_24

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  • DOI: https://doi.org/10.1007/978-0-387-89508-6_24

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-89507-9

  • Online ISBN: 978-0-387-89508-6

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