ArticleJournal of orthopaedic surgery and research2015
Complications are reduced with a protocol to standardize timing of fixation based on response to resuscitation.
Article in Journal of orthopaedic surgery and research, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 38 papers, 3 of them syntheses that pooled it.
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Who cites it
38 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Early vs. late definitive fixation of pelvic ring fractures in resuscitated polytraumatized patients: a systematic review and meta-analysis.Archives of orthopaedic and trauma surgery · 2025Pooled it
- The association between interleukin-8 gene polymorphism and the risk of sepsis in older adults.Journal of orthopaedic surgery and research · 2024Pooled it
- 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 : official publication of the European Trauma Society · 2024Pooled it
- Clinical efficacy of ulinastatin and budesonide combination therapy in pelvic fracture complicated by pulmonary contusion.European journal of medical research · 2025Trial
- Lung complications are common in intensive care treated patients with pelvis fractures: a retrospective cohort study.Scandinavian journal of trauma, resuscitation and emergency medicine · 2016Trial
- Floating knee injuries: a retrospective analysis of treatment outcomes and prognostic factors.Irish journal of medical science · 2026Article
- Article
- Evaluating Early Appropriate Care Criteria for Acute Axial and Lower Extremity Fractures: A Large Database Propensity-Matched Cohort Study.Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews · 2025Article
- Review
- Review
- Fatal fat embolism syndrome in a young trauma patient with a stable initial presentation: time to define predictive criteria? A case report.Journal of trauma and injury · 2025Article
- Single-stage definitive fixation for floating hip injuries: evaluating functional outcomes and complications.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2025Article
- A China-Based exploration of surgical timing for polytrauma with a focus on fracture reconstruction.World journal of emergency surgery : WJES · 2025Article
- Assessing the utility of routine postoperative radiographs in pelvic and acetabular trauma Surgery.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2025Article
- Translating Biomarker Research into Clinical Practice in Orthopaedic Trauma: A Systematic Review.Journal of clinical medicine · 2025Review
- 1-Year Follow-Up Result of Early Definitive Management of the Trauma Patient in a Tertiary Health Care Centre.Journal of orthopaedic case reports · 2025Article
- Managing severe (and open) pelvic disruption.Trauma surgery & acute care open · 2025Review
- Analysis of factors influencing the surgical treatment outcomes of spinal injuries in polytrauma patients.Annals of medicine and surgery (2012) · 2024Article
- Clinical Assessment and Factors Influencing Treatment Strategy and Outcomes in Complex Limb Injuries.Cureus · 2024Review
- Management of floating hip injury: a review of the literature.EFORT open reviews · 2024Article
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Authors and funding
9 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundOur group developed a protocol, entitled Early Appropriate Care (EAC), to determine timing of definitive fracture fixation based on presence and severity of metabolic acidosis. We hypothesized that utilization of EAC would result in fewer complications than a historical cohort and that EAC patients with definitive fixation within 36 h would have fewer complications than those treated at a later time.
methodsThree hundred thirty-five patients with mean age 39.2 years and mean Injury Severity Score (ISS) 26.9 and 380 fractures of the femur (n = 173), pelvic ring (n = 71), acetabulum (n = 57), and/or spine (n = 79) were prospectively evaluated. The EAC protocol recommended definitive fixation within 36 h if lactate <4.0 mmol/L, pH ≥7.25, or base excess (BE) ≥-5.5 mmol/L. Complications including infections, sepsis, DVT, organ failure, pneumonia, acute respiratory distress syndrome (ARDS), and pulmonary embolism (PE) were identified and compared for early and delayed patients and with a historical cohort.
resultsAll 335 patients achieved the desired level of resuscitation within 36 h of injury. Two hundred sixty-nine (80%) were treated within 36 h, and 66 had protocol violations, treated on a delayed basis, due to surgeon choice in 71%. Complications occurred in 16.3% of patients fixed within 36 h and in 33.3% of delayed patients (p = 0.0009). Hospital and ICU stays were shorter in the early group: 9.5 versus 17.3 days and 4.4 versus 11.6 days, respectively, both p < 0.0001. This group of patients when compared with a historical cohort of 1443 similar patients with 1745 fractures had fewer complications (16.3 versus 22.1%, p = 0.017) and shorter length of stay (LOS) (p = 0.018).
conclusionsOur EAC protocol recommends definitive fixation within 36 h in resuscitated patients. Early fixation was associated with fewer complications and shorter LOS. The EAC recommendations are safe and effective for the majority of severely injured patients with mechanically unstable femur, pelvis, acetabular, or spine fractures requiring fixation.
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