Department of Orthopaedics, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag 7, Congella 4013, South Africa.
Injury. 2012 Feb;43(2):219-22. doi: 10.1016/j.injury.2011.08.023. Epub 2011 Sep 9.
Fracture management in polytrauma patients has favoured early definitive fracture fixation with some authors advocating a staged management approach in these potentially unstable patients. We aimed to investigate the timing of surgical fracture stabilisation in polytrauma patients with significant orthopaedic injuries in a Level 1 trauma unit in South Africa (RSA) and to compare its performance with Level 1 trauma units in the USA and Europe.
A retrospective review was performed extracting polytrauma patients with a New Injury Severity Score (NISS) ≥ 15, with significant pelvic or long bone fractures managed surgically. We compared these data with recently published data from the USA and Europe.
Over a 3 year period pedestrian (46.3%) and motor vehicle or motorcycle accidents (40.7%) were the predominant mechanisms of injury in the 123 eligible patients. Compared to international data, patients were significantly younger (32.41 years (SD 13.4) vs. USA 44.1 years (SD 16.39) and Germany 41.2 years (SD 15.35), p < 0.001); and had a higher NISS score (RSA 31.93 (10.3), USA 27.4 (8.65), Germany 29.4 (6.88), p = 0.007). Less definitive fixation took place in the first 24h (RSA 37.4%, USA 57.1%, Germany 65.6%, p < 0.001), but overall definitive fixation took place earlier (RSA 3.6 days (SD 4.39), USA 5.5 days (SD 4.2), Germany 6.6 days (SD 8.7), p = 0.001).
In a developing country when compared to international trauma centres, less primary definitive fixation was performed in the first 24h.
多发创伤患者的骨折管理倾向于早期确定性骨折固定，一些作者主张对这些潜在不稳定的患者采用分期管理方法。我们旨在调查南非（RSA）1 级创伤单位中严重骨科损伤的多发创伤患者的手术骨折稳定的时间，并将其与美国和欧洲的 1 级创伤单位进行比较。
对新损伤严重程度评分（NISS）≥15 的多发创伤患者进行回顾性分析，这些患者接受了手术治疗的骨盆或长骨骨折。我们将这些数据与最近发表的来自美国和欧洲的数据进行比较。
在 3 年期间，行人（46.3%）和机动车或摩托车事故（40.7%）是 123 名符合条件的患者中主要的损伤机制。与国际数据相比，患者明显更年轻（32.41 岁（SD 13.4）与美国 44.1 岁（SD 16.39）和德国 41.2 岁（SD 15.35）相比，p<0.001），且 NISS 评分更高（RSA 31.93（10.3），美国 27.4（8.65），德国 29.4（6.88），p=0.007）。在 24 小时内进行的确定性固定治疗更少（RSA 37.4%，美国 57.1%，德国 65.6%，p<0.001），但总体上确定性固定治疗更早（RSA 3.6 天（SD 4.39），美国 5.5 天（SD 4.2），德国 6.6 天（SD 8.7），p=0.001）。
在发展中国家，与国际创伤中心相比，在最初的 24 小时内进行的主要确定性固定治疗较少。
