The 2+2 Rule in the Management of Long Bone Fractures in Patients with Severe Multiple Trauma

• Authors: Leszek Brongel , Wiesław Jarzynowski , Piotr Budzyński , Waldemar Hładki , Jacek Lorkowski , Marek Kuliś
• Languages of publication: EN

Abstracts

EN

The aim of the study was to estimate the efficacy of surgically stabilizing long bone fractures within 48 hours in patients with severe multiple injuries following life-saving procedures and compensating for circulatory-respiratory parameters.Material and methods. The study comprised 364 patients with multiple injuries scoring 7 or more LSO points, who were admitted and treated university department during 1992-2000. Upon admission patients were documented on the basis of computer case histories of diseases and the standard calculation sheets. The assumption was that all long bone fractures in patients with multiple trauma would be stabilized within 48 hours. Parameters for operating were set so that the duration time of the operative procedure could not exceed 2 hours, and the amount of blood transfused could not exceed 2 units.Results. From among 364 patients with multiple traumas scoring 7 or more LSO points, 192 patients sustained long bone fractures that required surgical attention. One-third of the patients were female, the average age of the patients was nearly 45 years, and the average injure severity was 10.28 LSO points. 146 patients underwent 226 orthopaedic operations, out of which 127 were carried out in the first 24 hours, and 23 in the next 24 hours of the hospital stay. The mortality was 13.5%.Conclusions. Stabilization of the long bone fractures within the first 48 hours in patients with multiple traumas, after compensating circulatory parameters, is a life-saving treatment.

Keywords

EN

multiple trauma; bone fractures; multiple organ failure; orthopaedic damage control; inflammatory response

• Publisher: Index Copernicus International
• Journal: Polish Journal of Surgery
• Year: 2009
• Volume: 81
• Issue: 11
• Pages: 526-531

Dates

published

1 - 11 - 2009

online

24 - 12 - 2009

Contributors

author

Leszek Brongel

• Department of Emergency Medicine and Multiple Trauma, 2 Chair of General Surgery Medical College Jagiellonian University in Cracow

author

Wiesław Jarzynowski

• Department of Emergency Medicine and Multiple Trauma, 2 Chair of General Surgery Medical College Jagiellonian University in Cracow

author

Piotr Budzyński

• Department of Emergency Medicine and Multiple Trauma, 2 Chair of General Surgery Medical College Jagiellonian University in Cracow

author

Waldemar Hładki

• Department of Emergency Medicine and Multiple Trauma, 2 Chair of General Surgery Medical College Jagiellonian University in Cracow

author

Jacek Lorkowski

• Department of Emergency Medicine and Multiple Trauma, 2 Chair of General Surgery Medical College Jagiellonian University in Cracow

author

Marek Kuliś

• Department of Emergency Medicine and Multiple Trauma, 2 Chair of General Surgery Medical College Jagiellonian University in Cracow

References

• Goris RJA: The Injury Severity Score. World J Surg 1983; 7: 12-18.[Crossref][PubMed]
• Tscherne H, Oestern HJ, Sturm J: Osteosynthesis of major fractures in polytrauma. World J Surg 1983; 7: 80-87.[PubMed][Crossref]
• Baue AE, Durham RM, Mazuski JE: Clinical trials of new and novel therapeutic agents. World J Surg 1996; 20: 493-98.[PubMed][Crossref]
• Brongel L: One-day surgery in multiple trauma patients. Przegl Lek 2000; 57 (suppl.5): 133-35.[PubMed]
• Baue AE, Faist E: Multiple Organ Failure - summary. World J Surg 1996; 20: 499-502.
• Blow O, Magliore L, Claridge JA et al.: The golden hour and the silver day: detection and correction of occult hypoperfusion within 24 hours improves outcome after major trauma. J Trauma 1999; 47: 964-69.[PubMed][Crossref]
• Flohe S, Lendemans S, Schade FU et al.: Influence of surgical intervention in the immune response of severely injured patients. Intensive Care Med 2004; 30: 96-102.
• Hietbrink F, Koenderman L, Rijkers G et al.: Trauma: the role of the innate immune system. World J Emerg Surg 2006; 20: 1-15.
• Sauaia A, Moore FA, Moore EE et al.: Early risk factors for postinjury multiple organ failure. World J Surg 1996; 20: 392-400.[PubMed][Crossref]
• Schulman AM, Claridge JA, Carr G et al.: Predictors of patients who will develop prolonged occult hypoperfusion following blunt trauma. J Trauma 2004; 57: 795-800.[Crossref]
• Sherwood ER, Toliver-Kinsky T: Mechanisms of the inflammatory response. Best Practice & Research Clinical Anesthesiology 2004; 18: 385-405.
• Allgöver M, Border JM: Advances in the care of the multiple trauma patients. World J Surg 1983; 7: 1-3.[Crossref]
• Burch JM: New Cocepts in Trauma. Am J Surg 1997; 173: 44-46.[Crossref]
• Hupel TM, Aksenov SA, Schemitsch EH: Muscle perfusion after intramedullary nailing of the canine tibia. J Trauma 1998; 45: 256-62.[PubMed][Crossref]
• Linström T, Gullichsen E, Riutta A: The effect of unreamed and reamed intramedullary nailing on the urinary excretion of prostacyclin and thromboxane A2 metabolites in patients with tibial shaft fractures. J Trauma 1998; 45: 743-46.[Crossref]
• Pape HC, Bartels M, Pohlemann T et al.: Coagulatory response after femoral instrumentation after severe trauma in sheep. J Trauma 1998; 45: 720-28.[PubMed][Crossref]
• Schemitsch EH, Turchin DC, Anderson GI et al.: Pulmonary and systemic fat embolisation after medullary canal pressurization: a hemodynamic and histologic investigation in the dog. J Trauma 1998; 45: 738-42.[Crossref]
• Aufmkolk M, Neudeck F, Voggenreiter G et al.: Effect of primary femoral plate osteosynthesis on the course of polytrauma patients with or without thoracic trauma. Unfallchirurg 1998; 101: 433-39.[Crossref]
• Nast-Kolb D: Intramedullary nailing in polytrauma. Pro and contra early management. Unfallchirurg 1997; 100: 80-84.
• Kazakos KJ, Verettas DJ, Tilkeridis K et al.: External fixation of femoral fractures in multiply injured intensive care unit patients. Acta Orthop Belg 2006; 72: 39-43.[PubMed]
• Nast-Kolb D, Ruchholtz S, Waydhas C et al.: Damage control orthopedics. Unfallchirurg 2005; 108: 804-11.[Crossref][WoS]
• Renaldo N, Egol K: Damage-control orthopedics: evolution and practical applications. Am J Orthop 2006; 35: 285-91.[PubMed]
• Roberts CS, Pape HC, Jones AL et al.: Damage control orthopaedics: evolving concepts in the treatment of patients who have systained orthopaedic trauma. Instr Course Lecture 2005; 54: 447-62.
• Lübek T, Misztal M, Jankiewicz L i wsp.: Strategia leczenia złamań podudzia. Ostry dyżur 2009; 2(2): 27-29
• Słowiński W, Słowiński K: Co nowego w leczeniu złamań na początku XXI wieku? Chir Narz Ruchu 2005; 70(3): 223-26.
• Słowiński K, Twardosz W, Koźlan-Pawlaczyk M: Kontrowersje wokół działań diagnostyczno-leczniczych w pierwszym okresie po urazie. W: Intensywna terapia pod red. K. Kuszy i Z. Szkulmowskiego. Poznań 2006; 261-270.

Identifiers

DOI

10.2478/v10035-009-0085-y