Developments in the understanding of staging a “major fracture” in polytrauma: results from an initiative by the polytrauma section of ESTES

European Journal of Trauma and Emergency Surgery, 2024 · DOI: https://doi.org/10.1007/s00068-023-02245-5 · Published: February 23, 2023

Surgery Trauma Orthopedics

Simple Explanation

This study examines how the understanding and definition of a 'major fracture' in polytrauma patients has evolved over time, focusing on surgical treatment strategies. The research investigates the influence of fracture location, associated injuries, and patient physiology on surgical decision-making in polytrauma cases. The findings highlight a shift from primarily focusing on femur fractures to considering pelvic and spinal fractures, alongside factors like chest trauma, head injuries, and hemodynamic stability.

Study Duration

Not specified

Participants

74 studies included for qualitative evaluation

Evidence Level

Systematic Review

Key Findings

1
Femur fractures were the most frequently investigated anatomic region, particularly in earlier studies focusing on a single anatomic region.
2
After 2010, fractures of the pelvis and spine were cited more frequently, indicating a change in focus over time.
3
Associated conditions like chest injuries, traumatic brain injury (TBI), and hemorrhagic shock significantly influence surgical decision-making.

Research Summary

This systematic review analyzes the evolution of understanding 'major fractures' in polytrauma patients and their influence on surgical strategies. The study demonstrates a shift from a singular focus on femur fractures to a more comprehensive consideration of pelvic, spinal, and acetabular fractures. The findings emphasize the increasing importance of physiological factors, injury-specific conditions, and hemodynamic stability in determining surgical priorities.

Practical Implications

Refining Fracture Definition

The study suggests a need for a more comprehensive definition of 'major fracture' that includes physiological responses and associated injuries, not just anatomic location.

Improving Surgical Strategies

The research supports a patient-centered approach that considers the timing of fracture fixation in relation to overall patient stability and functional outcomes.

Future Research Directions

Further studies should focus on weighting different fractures based on their effects on physiological response and potential complications, including soft tissue damage and neurovascular injuries.

Study Limitations

1
Inaccessibility of certain older references.
2
Heterogeneity within the included studies in respect to study populations, study designs and outcome parameters.
3
Limited ability to account for or quantify soft tissue injury.

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