Authors: Orcun Sahin
Abstract
Introduction
This study analyzed the clinical and radiological outcomes of geriatric polytrauma patients who had multiple fractures surgically treated and a minimum of 2 years of follow-up.
Methods
Eighty-six geriatric patients with polytrauma and multiple fractures which were surgically treated in orthopedics and who had a minimum of 2 years of follow-up were retrospectively analyzed. Patients’ demographic characteristics, comorbidities, and follow-up time were recorded. The mechanism of injury, fracture type and location, Injury Severity Score (ISS), American Society of Anesthesiologists (ASA) score, duration of hospital stay, complications, and 1-year mortality were also recorded. Fracture union, implant failure, and refractures/misalignment were analyzed from radiographs.
Results
There were 34 (39.5%) male and 52 (60.5%) female patients. Mean age was 73.5 years with an average follow-up time of 32.9 months. Patients had more low-energy traumas and more lower extremity, comminuted fractures. On the contrary, high-energy traumas and femur/pelvic fracture surgeries had higher associated mortality. The mean ISS score was 26.3. The most common ASA score was ASA 3 (75.8%). The most common clinical and radiological complications were prolonged wound drainage and implant failure. The total 1-year mortality rate was 22.1%. Patients with high ASA scores and patients with lower extremity fractures (femoral/pelvic fractures) also had significantly increased mortality rates. No significant relation was detected between mortality and ISS, fracture type, number of fractures, and duration of hospital stay.
Conclusion
Orthopedic surgeons must be alert about the possible complications of femoral fractures and comminuted fractures including pelvic girdle. Surgically treated, multifractured patients with high-energy trauma, advanced age, and high ASA scores are also at risk for mortality regardless of the ISS, comorbidities, and duration of hospital stay. Pulmonary thromboemboli must be kept in mind as a significant complication for mortality.
Key Summary Points |
Why carry out this study?There is no definitive guideline in the literature for the management of polytraumatized elderly patients with multiple fractures in need of surgical treatment. Hence, we intend to make a contribution to the literature about this controversial issue and try to reveal the best possible approach for surgically treated, polytraumatized elderly patients with multiple fractures. |
What was learned from the study?Polytraumatized elderly patients with multiple fractures who undergo orthopedic surgery should be meticulously evaluated with a multidisciplinary approach in order to prevent age-related complications (especially pulmonary thromboemboli) and to decrease mortality rates. Orthopedic surgeons must be alert, especially to the possible adverse outcomes of the lower extremity (femoral fractures) and comminuted fractures including the pelvic girdle, caused by low-energy traumas. Surgically treated, multifractured patients with high-energy trauma, advanced age, and high ASA scores are at risk for mortality regardless of the Injury Severity Score (ISS), comorbidities, and duration of hospital stay. |