Header

UZH-Logo

Maintenance Infos

Strategies for the treatment of femoral fractures in severely injured patients: trends in over two decades from the TraumaRegister DGU ®


Bläsius, Felix M; Laubach, Markus; Andruszkow, Hagen; Lichte, Philipp; Pape, Hans-Christoph; Lefering, Rolf; Horst, Klemens; Hildebrand, Frank (2021). Strategies for the treatment of femoral fractures in severely injured patients: trends in over two decades from the TraumaRegister DGU ®. European Journal of Trauma and Emergency Surgery:Epub ahead of print.

Abstract

PURPOSE

Treatment strategies for femoral fracture stabilisation are well known to have a significant impact on the patient's outcome. Therefore, the optimal choices for both the type of initial fracture stabilisation (external fixation/EF, early total care/ETC, conservative treatment/TC) and the best time point for conversion from temporary to definitive fixation are challenging factors.

PATIENTS

Patients aged ≥ 16 years with moderate and severe trauma documented in the TraumaRegister DGU$^{®}$ between 2002 and 2018 were retrospectively analysed. Demographics, ISS, surgical treatment strategy (ETC vs. EF vs. TC), time for conversion to definitive care, complication (MOF, sepsis) and survival rates were analysed.

RESULTS

In total, 13,091 trauma patients were included. EF patients more often sustained high-energy trauma (car: 43.1 vs. 29.5%, p < 0.001), were younger (40.6 vs. 48.1 years, p < 0.001), were more severely injured (ISS 25.4 vs. 19.1 pts., p < 0.001), and had higher sepsis (11.8 vs. 5.4%, p < 0.001) and MOF rates (33.1 vs. 16.0%, p < 0.001) compared to ETC patients. A shift from ETC to EF was observed. The time until conversion decreased for femoral fractures from 9 to 8 days within the observation period. Sepsis incidences decreased in EF (20.3 to 12.3%, p < 0.001) and ETC (9.1-4.8%, p < 0.001) patients.

CONCLUSIONS

Our results show the changes in the surgical treatment of severely injured patients with femur fractures over a period of almost two decades caused by the introduction of modern surgical strategies (e.g., Safe Definitive Surgery). It remains unclear which subgroups of trauma patients benefit most from these strategies.

Abstract

PURPOSE

Treatment strategies for femoral fracture stabilisation are well known to have a significant impact on the patient's outcome. Therefore, the optimal choices for both the type of initial fracture stabilisation (external fixation/EF, early total care/ETC, conservative treatment/TC) and the best time point for conversion from temporary to definitive fixation are challenging factors.

PATIENTS

Patients aged ≥ 16 years with moderate and severe trauma documented in the TraumaRegister DGU$^{®}$ between 2002 and 2018 were retrospectively analysed. Demographics, ISS, surgical treatment strategy (ETC vs. EF vs. TC), time for conversion to definitive care, complication (MOF, sepsis) and survival rates were analysed.

RESULTS

In total, 13,091 trauma patients were included. EF patients more often sustained high-energy trauma (car: 43.1 vs. 29.5%, p < 0.001), were younger (40.6 vs. 48.1 years, p < 0.001), were more severely injured (ISS 25.4 vs. 19.1 pts., p < 0.001), and had higher sepsis (11.8 vs. 5.4%, p < 0.001) and MOF rates (33.1 vs. 16.0%, p < 0.001) compared to ETC patients. A shift from ETC to EF was observed. The time until conversion decreased for femoral fractures from 9 to 8 days within the observation period. Sepsis incidences decreased in EF (20.3 to 12.3%, p < 0.001) and ETC (9.1-4.8%, p < 0.001) patients.

CONCLUSIONS

Our results show the changes in the surgical treatment of severely injured patients with femur fractures over a period of almost two decades caused by the introduction of modern surgical strategies (e.g., Safe Definitive Surgery). It remains unclear which subgroups of trauma patients benefit most from these strategies.

Statistics

Citations

Dimensions.ai Metrics

Altmetrics

Downloads

2 downloads since deposited on 22 Feb 2021
2 downloads since 12 months
Detailed statistics

Additional indexing

Contributors:Trauma Register DGU®
Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Department of Trauma Surgery
Dewey Decimal Classification:610 Medicine & health
Language:German
Date:15 February 2021
Deposited On:22 Feb 2021 16:17
Last Modified:01 Mar 2021 16:32
Publisher:Springer
ISSN:1863-9933
OA Status:Hybrid
Free access at:PubMed ID. An embargo period may apply.
Publisher DOI:https://doi.org/10.1007/s00068-020-01599-4
PubMed ID:33590272

Download

Hybrid Open Access

Download PDF  'Strategies for the treatment of femoral fractures in severely injured patients: trends in over two decades from the TraumaRegister DGU ®'.
Preview
Content: Published Version
Filetype: PDF
Size: 1MB
View at publisher
Licence: Creative Commons: Attribution 4.0 International (CC BY 4.0)