Definitive Surgery Is Safe in Borderline Patients Who Respond to Resuscitation

Area of Science:

• Orthopedic Surgery
• Trauma Care
• Surgical Outcomes

Background:

• Borderline polytrauma patients with long bone or pelvic fractures often require surgical intervention.
• The optimal timing for definitive fracture stabilization in these patients remains a subject of debate.
• Concerns exist regarding potential increases in postoperative complications with early surgical intervention.

Purpose of the Study:

• To investigate the safety and efficacy of early definitive stabilization (EDS) in adequately resuscitated borderline polytrauma patients.
• To determine if EDS, performed within 4 days, increases the need for postoperative ventilation or complications.
• To compare outcomes between EDS and delayed surgical fixation.

Main Methods:

• Retrospective cohort study involving 103 borderline polytrauma patients with femur, tibia, or pelvic fractures.
• Patients were categorized based on treatment: Early Total Care or Damage Control Orthopaedics.
• Timing of definitive surgical fixation was classified as EDS (within 4 days) or late (>4 days).

Main Results:

• 50.5% of patients underwent EDS, while 49.5% had late definitive surgery.
• Logistic regression identified units of blood transfused and time to definitive surgery > 4 days as predictive of increased postoperative ventilation (≥ 3 days).
• Increased age, severe head injury (AIS ≥ 3), and time to definitive surgery were associated with higher complication rates.

Conclusions:

• Adequately resuscitated borderline polytrauma patients without severe chest or head injuries can undergo EDS safely.
• Early definitive stabilization within 4 days does not appear to increase postoperative ventilation or complications in this select patient group.
• This finding supports considering EDS for eligible patients to potentially improve outcomes.