Immediate mortality following multiple trauma occurs from brain injury and massive bleeding. Late mortality (i.e., 7 days or more after admission), however, arises from sepsis and multiple organ failure which often includes respiratory
dysfunction
or
failure. Many previous reports of patients dying from trauma had sepsis following skeletal injuries. Until the mid-1970s, management of fractures in patients with multiple trauma as a rule had employed conservative skeletal traction and cast
immobilization. A high priority was given only to those injuries posing immediate threat to life or limb viability. Operative stabilization of fractures on the day of admission was considered not necessary since it may require prolonged
anaesthesia
and
additional blood loss.
Several authors attempted early operative management of long bone and pelvic fractures in mid-1970's and reported beneficial effects of being capable of preventing "fat embolism syndrome" and various pulmonary complications, thereby increasing
increasing the chance of survival. It appears now that prolonged skeletal traction of femur increases the duration of pulmonary septic state as well as the incidence of fracture complications. Postponing orthopedic intervention often means
prolonged
ventilatory supoort. a greater need for antibiotics, delayed introduction of enteral nutrition. and a greater degree of sepsis.
In a retrospective involving abdominal trauma patients card for over a three year period, we looked at the effects of skeletal fracture that occurred in the victims of multiple blunt trauma to include trauma to the abdomen(N=166). The prognosis
was
studied, especially in relation to the timing and type of treatment measures taken.
In abdominal blunt trauma patients, 75 patients (45.2%) had multiple fractures. The kidney was the most commonly injured organ(N=61/166,36.7%), followed by the liver(N=43/166, 25.9%). Fracture(s) involving, the chest bones(ribs, sternum, scapula,
or
clavicle) was the most common fracture(N=50/166), followed by fractures of pelvis(N=34/166), lower extremities(N=33/166), and spine(N=29/166).
The complication rate following blunt abdominal trauma was 33.1%. It was more frequent in patients with associated fracture(s)46.7%) than without fractures(22.0%)(p<0.05); particularly of note was the pulmonary complication rate(21.0% versus
7.8%,
p<0.05), It was not certain whether this difference was attributed to the failure of early surgical fixation of the fractures was the case in many of our patients. The timing of fracture management after the trauma, often crucial in determining
prognosis, was not so available in many patients.
It appeared from the logistic regression analysis that in blunt trauma involving fracture (S), Injury Severity Score(ISS) was a significant risk factor predicting complications(p<0.05). Respiratory complications seemed to be significantly related
to
Revised Trauma Score(RTS)(p<0.05). Early surgical fixation of the fracture(s) in multiple blunt trauma patients often led to shorter stay in the intensive care unit(ICU), in turn, decreasing the ill effects of a protracted ICU stay.
In conclusion, the blunt trauma patients with accompanying fractures appear to fare better if they undergo prompt management of the fractures following resuscitation and management of life-threatening conditions sustained by the trauma. The
option
of
early surgical fixation of fractures should be among the first priorities in the management of trauma patients.
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