Collocated burn and fracture injuries in major trauma: a 10 year experience

Collocated burn and fracture injuries, defined as a burn overlying the site of a fracture, represent a serious subset of major burns and trauma. The literature pertaining to these rare injuries is inconclusive. Recent studies cast doubt on the safety of operative fixation in this population. No study to date has examined outcomes of collocated burn and fracture injuries compared with control. The aim of this study was to compare characteristics, injury patterns and complication rates in major burns and fracture patients with a collocated injury to those without.

A retrospective chart review of all consecutive patients with dermal burns and major fractures were undertaken between January 2005 and December 2015 at a tertiary referral trauma hospital. Outcomes assessed included demographics, injury characteristics and complications, including infection. Orthopaedic infection was defined as orthopaedic surgical site infection or osteomyelitis.

Of the 40 patients identified, 21 subjects sustained collocated injuries. Patients with collocated injuries demonstrated a trend towards higher injury severity, higher percentage of total body surface area affected, longer length of stay and greater overall and orthopaedic complication rate. Significant predictors of orthopaedic infection were related to injury severity rather than collocation or operative management.

There are differences in the characteristics and complication rates between collocated and non-collocated burn and fracture injuries. Collocated injuries tend to result from greater energy mechanisms, undergo longer inpatient stays and demonstrate increased morbidity. Injury severity appears to be the most important factor in determining postoperative orthopaedic infection. These characteristics must be considered when managing these rare but significant injuries.