To analyse the influence of upper extremity trauma on the long-term
outcome of polytraumatised patients. A total of 629 multiply injured patients were included in a follow-up
study at least ten years after injury (mean age 26.5 years, standard
deviation 12.4). The extent of the patients’ injury was classified
using the Injury Severity Score. Outcome was measured using the
Hannover Score for Polytrauma Outcome (HASPOC), Short Form (SF)-12, rehabilitation
duration, and employment status. Outcomes for patients with and
without a fracture of the upper extremity were compared and analysed
with regard to specific fracture regions and any additional brachial
plexus lesion.Aims
Patients and Methods
We report the functional and socioeconomic long-term
outcome of patients with pelvic ring injuries. We identified 109 patients treated at a Level I trauma centre
between 1973 and 1990 with multiple blunt orthopaedic injuries including
an injury to the pelvic ring, with an Injury Severity Score (ISS)
of ≥ 16. These patients were invited for clinical review at a minimum
of ten years after the initial injury, at which point functional
results, general health scores and socioeconomic factors were assessed. In all 33 isolated anterior (group A), 33 isolated posterior
(group P) and 43 combined anterior/posterior pelvic ring injuries
(group A/P) were included. The mean age of the patients at injury
was 28.8 years (5 to 55) and the mean ISS was 22.7 (16 to 44). At review the mean Short-Form 12 physical component score for
the A/P group was 38.71 (22.12 to 56.56) and the mean Hannover Score
for Polytrauma Outcome subjective score was 67.27 (12.48 to 147.42),
being significantly worse compared with the other two groups (p =
0.004 and p = 0.024, respectively). A total of 42 patients (39%)
had a limp and 12 (11%) required crutches. Car or public transport
usage was restricted in 16 patients (15%). Overall patients in groups
P and A/P had a worse outcome. The long-term outcome of patients
with posterior or combined anterior/posterior pelvic ring injuries
is poorer than of those with an isolated anterior injury. Cite this article:
For femoral shaft fracture, damage control orthopaedics entails primary external fixation and subsequent conversion to an intramedullary device (IMN). Sub-clinical contamination of external fixator pin sites is common and it is argued that such an approach risks subsequent local infective complications. We aimed to determine the rate of wound infection following DCO procedures and primary IMN for femoral fracture stabilisation. Retrospective analysis of a prospectively assembled adult patient database was carried out. Inclusion criteria were femoral #, New Injury Severity Score (NISS) above 20 and survival more than 2 weeks. Two groups, damage control (DCO) and early total care (ETC) (Primary Nail), were formed. Contamination was positive culture from the wound or fixator pin-sites without clinical infection. Superficial infection was a combination of positive bacterial swabs and local or systemic signs of infection. Deep infection was any case requiring surgical intervention with a sub-group requiring removal of femoral metal work (ROMW) also defined. 173 patients met the criteria for inclusion, with 192 fractures (19 bilateral). The mean follow up was 19 months. Patients in the damage control group were more severely injured than those undergoing primary intramedullary nailing (NISS 36 vs 25, p 0.001). There were also more severe (Grade 3 A,B or C) local soft tissue injuries in this group (p 0.05). 98 of the 111 DCO patients underwent subsequent IMN. Others either died without conversion being appropriate, or it was elected to complete treatment with external fixation. The mean time of exchange an ex/fix to a nail was 14.1 days. Though contamination rates were higher in the DCO group (12.6% vs 3.7%, p 0.05), there was no excess of infective complications (11.1% vs 10.8%). Contamination increased significantly in patients who underwent conversion to IMN after 14 days. Grade 3 open injury was significantly associated with infection irrespective of treatment. This study demonstrates that infection rates following DCO for femoral fractures are not significantly different to those observed following primary intramedullary nailing. Whilst the overall risk of deep infection in the DCO group did not show any correlation with the timing of converting the external fixator to a nail, the risk of contamination was higher in patients where the exchange nailing was performed after a period of 2 weeks.