Timing of Orthopaedic Surgery in Multiple Trauma Patients

OBJECTIVES: The purpose was to define which clinical conditions warrant delay of definitive fixation for pelvis, femur, acetabulum, and spine fractures. A model was developed to predict the complications. DESIGN: Statistical modeling based on retrospective database. SETTING: Level 1 trauma center. PATIENTS: A total of 1443 adults with pelvis (n = 291), acetabulum (n = 399), spine (n = 102), and/or proximal or diaphyseal femur (n = 851) fractures. INTERVENTION: All fractures were treated surgically. MAIN OUTCOME MEASUREMENTS: Univariate and multivariate analysis of variance assessed associations of parameters with complications. Logistic predictive models were developed with the incorporation of multiple fixed and random effect covariates. Odds ratios, F tests, and receiver operating characteristic curves were calculated. RESULTS: Twelve percent had pulmonary complications, with 8.2% overall developing pneumonia. The pH and base excess values were lower (P 7.25 was associated with fewer pulmonary complications. Presence and severity of chest injury, number of fractures, and timing of fixation are other significant variables to include in a predictive model and algorithm development for Early Appropriate Care. The goal is to minimize complications by definitive management of major skeletal injury once the patient has been adequately resuscitated.