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Polytrauma Patients With Associated Spine Fractures: An Assessment of Surgical Intervention on Patient Outcome
Steven R Niedermeier1, Safdar N Khan
1Department of Orthopaedics, Wexner Medical Center, The Ohio State University, Columbus, OH.
Study Design:
Retrospective comparative study.
Objective:
To examine perioperative characteristics among polytraumatized patients with operative, unstable spine fractures with and without concomitant operative long bone injuries.
Summary Of Background Data:
Treatment of polytrauma patients has delicate and time-sensitive protocols to ensure successful recovery. The literature defines standards for vertebral injury and surgical intervention.
Data:
Severely polytraumatized patients with an Injury Severity Score (ISS)≥15 were divided according to those with operative spine fractures with operative long bone fractures (OSFLBF) and those with operative spine fractures alone (OSFA).
Methods:
Patients were compared by sex, age, mechanism of injury (MOI), ISS, location of injuries, time spent inpatient before procedure(s), total time in the operating room, type of procedure(s) performed, estimated operative blood loss, complications, length of stay (LOS), and time to discharge.
Results:
In a 12-year period, >600 patients were admitted to our level I trauma center with polytrauma and unstable spine fracture. Twelve had sustained operative unstable spine injuries and 21 had unstable spine injuries with a long bone injury requiring operative stabilization. Significant differences in ISS, LOS, MOI, region of vertebral injury, or total operating room time between the 2 groups were not observed. Differences were seen concerning average blood loss during surgery and time spent inpatient before entering the operating room. OSFLBF patients were discharged at a faster rate after 20 days compared with OSFSA patients.
Conclusions:
No differences in ISS, LOS, MOI, region of vertebral injury or vertebral procedure, or total operating room time were observed. Blood loss was more substantial in the OSFLBF group, but it spent fewer days in the hospital preoperatively. Despite a nonstatistical difference in LOS, a larger proportion of OSFA patients remained in the hospital after being inpatient for >20 days, reducing the risk for iatrogenic complication in that group compared with OSFA.
Level Of Evidence:
III, retrospective comparative.
