Fracture stabilisation in a polytraumatised African population--a comparison with international management practice

Fracture management in polytrauma patients has favoured early definitive fracture fixation with some authors advocating a staged management approach in these potentially unstable patients. We aimed to investigate the timing of surgical fracture stabilisation in polytrauma patients with significant orthopaedic injuries in a Level 1 trauma unit in South Africa (RSA) and to compare its performance with Level 1 trauma units in the USA and Europe.

A retrospective review was performed extracting polytrauma patients with a New Injury Severity Score (NISS) ≥ 15, with significant pelvic or long bone fractures managed surgically. We compared these data with recently published data from the USA and Europe.

Over a 3 year period pedestrian (46.3%) and motor vehicle or motorcycle accidents (40.7%) were the predominant mechanisms of injury in the 123 eligible patients. Compared to international data, patients were significantly younger (32.41 years (SD 13.4) vs. USA 44.1 years (SD 16.39) and Germany 41.2 years (SD 15.35), p < 0.001); and had a higher NISS score (RSA 31.93 (10.3), USA 27.4 (8.65), Germany 29.4 (6.88), p = 0.007). Less definitive fixation took place in the first 24h (RSA 37.4%, USA 57.1%, Germany 65.6%, p < 0.001), but overall definitive fixation took place earlier (RSA 3.6 days (SD 4.39), USA 5.5 days (SD 4.2), Germany 6.6 days (SD 8.7), p = 0.001).

In a developing country when compared to international trauma centres, less primary definitive fixation was performed in the first 24h.