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Incidence and risk factors for complications after definitive skeletal fixation of lower extremity in multiple injury patients: a retrospective chart review.

ABSTRACT: Background: The management of multiple injuries is complex. Type and timing of treatment for lower extremity fractures is a controversial subject. Although many studies have demonstrated the safety and effectiveness of early treatment, others have suggested that early definitive stabilization may cause complications, especially with chest and head injuries. The aim of this study was to determine the complications and effects of timing of fixation, and investigate risk factors for complications in multiple injuries patients with lower extremity fractures. Methods: A Retrospective chart review from Khon Kaen Trauma Registry between 2008 and 2015 were collected. All major complications were identified and collected for example acute respiratory distress syndrome (ARDS), acute kidney injury (AKI) and sepsis. The time to definitive skeletal fixation from initial injury was identified and analyzed with multiple logistic regression. Results: 1224 multiple injuries patients with lower extremity fractures were identified. The mean age was 34±19.5 years, 74.4% were male and 25.6% female. The mean time from initial injury to definitive operation was 55.7±53.9 hours. Complications occurred with 178 patients (14.5%), the most common of which were pneumonia, ARDS and AKI. After adjusting for sex, severity of injury, we found that the operation within 24-48 hours complication was 6.67 times less common than in the early treatment group (less than 24 hours) (95% CI: 3.03 to 10.00, P-value< 0.001). Conclusions: About 15% of the multiple injuries patients with lower extremity fracture had major complications. The optimal time for definitive fixation in lower extremity fractures to reduce complications was within 24-48 hours. We found that if we operated too early (before 24 hours) or more than 48 hours after the injury it could increase the morbidity and mortality.

SUBMITTER: Sangkomkamhang T

PROVIDER: S-EPMC5981188 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Incidence and risk factors for complications after definitive skeletal fixation of lower extremity in multiple injury patients: a retrospective chart review.

Sangkomkamhang Thananit T Thinkhamrop Wilaiphorn W Thinkhamrop Bandit B Laohasiriwong Wongsa W

F1000Research 20180518

<b>Background</b>: The management of multiple injuries is complex. Type and timing of treatment for lower extremity fractures is a controversial subject. Although many studies have demonstrated the safety and effectiveness of early treatment, others have suggested that early definitive stabilization may cause complications, especially with chest and head injuries. The aim of this study was to determine the complications and effects of timing of fixation, and investigate risk factors for complica ...[more]

PMID: 29904601

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Project description:BACKGROUND/OBJECTIVES:Limited studies suggest lower-extremity (LE) fractures are morbid events for nursing home (NH) residents. Our objective was to conduct a nationwide study comparing the incidence and resident characteristics associated with hip (proximal femur) vs nonhip LE (femoral shaft and tibia-fibula) fractures in the NH. DESIGN:Retrospective cohort study. SETTING:US NHs. PARTICIPANTS:We included all long-stay residents, aged 65 years or older, enrolled in Medicare from January 1, 2008, to December 31, 2009 (N = 1 257 279). Residents were followed from long-stay qualification until the first event of LE fracture, death, or end of follow-up (2 years). MEASUREMENTS:Fractures were classified using Medicare diagnostic and procedural codes. Function, cognition, and medical status were obtained from the Minimum Data Set prior to long-stay qualification. Incidence rates (IRs) were calculated as the total number of fractures divided by person-years. RESULTS:During 42 800 person-years of follow-up, 52 177 residents had an LE fracture (43 695 hip, 6001 femoral shaft, 2481 tibia-fibula). The unadjusted IRs of LE fractures were 1.32/1000 person-years (95% confidence interval [CI] = 1.27-1.38) for tibia-fibula, 3.20/1000 person-years (95% CI = 3.12-3.29) for femoral shaft, and 23.32/1000 person-years (95% CI = 23.11-23.54) for hip. As compared with hip fracture residents, non-hip LE fracture residents were more likely to be immobile (58.1% vs 18.4%), to be dependent in all activities of daily living (31.6% vs 10.8%), to be transferred mechanically (20.5% vs 4.4%), to be overweight (mean body mass index = 26.6 vs 24.0 kg/m2 ), and to have diabetes (34.8% vs 25.7%). CONCLUSIONS:Our findings that non-hip LE fractures often occur in severely functionally impaired residents suggest these fractures may have a different mechanism of injury than hip fractures. The resident differences in our study highlight the need for distinct prevention strategies for hip and non-hip LE fractures.

Project description:BACKGROUND:Wound complication rates after lower extremity vascular operative procedures stand as high as 40% and represent a major cause of morbidity, mortality, and cost. In view of increasing recognition of adipose tissue involvement in homeostasis and the response to injury, we hypothesized that adipose phenotype is linked to operative wound outcomes. METHODS:Clinical history, peripheral blood, and subcutaneous and perivascular adipose tissue were prospectively collected at the time of operation in patients undergoing lower extremity revascularization and lower extremity amputations. Nine biologic mediators (adiponectin; interleukin [IL]-1?, IL-6, and IL-8; leptin; monocyte chemoattractant protein-1; plasminogen activator inhibitor-1; resistin; and tumor necrosis factor) were assayed in the adipose tissues and plasma. The 30-day wound complications were captured in real time. Logarithmic transformation of mediator levels was performed based on positively skewed, non-Gaussian distribution, and data were compared using the Student t test. Bonferroni correction was used for multiple comparisons. RESULTS:Sixty-six patients undergoing lower extremity revascularization or lower extremity amputations for severe peripheral arterial disease were enrolled. The 30-day follow-up was 92.4%. In total, 19 (29%) patients developed wound complications. Patients who developed wound complications had elevated perivascular adiponectin levels (mean ± standard error, 2,372.45 ± 648.64 ng/mL vs 832.53 ± 180.54 ng/mL, P = .004). Perivascular IL-1? levels were lower among patients with wound dehiscence (0.41 ± 0.004 pg/mL vs 0.73 ± 0.09 pg/mL, P = .001). CONCLUSION:Local adipose tissue mediator levels at the time of operation demonstrate a previously undescribed compartment-specific relationship to wound outcomes in patients undergoing lower extremity vascular operative procedures. These associations provide fertile directives for defining the mechanisms underlying the pathogenesis of wound complications and their prevention.

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Incidence and risk factors for complications after definitive skeletal fixation of lower extremity in multiple injury patients: a retrospective chart review.

Publications

Incidence and risk factors for complications after definitive skeletal fixation of lower extremity in multiple injury patients: a retrospective chart review.

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