Choice of optimal time and type of orthopedic surgery in multiple injured patients with acute respiratory distress syndrome (ARDS) depending on age: retrospective study.

BACKGROUND

Multiple traumatic injuries are severe conditions with a high risk of complications. Hemorrhage, multiple organ failure syndrome (MOFS), systemic inflammatory response syndrome (SIRS) and sepsis are the most dangerous sequelae. ARDS (acute respiratory distress syndrome) is a part of MOFS. Despite new strategies of prevention and care, the mortality associated with these conditions still remains high.

MATERIALS AND METHODS

We conducted a retrospective study of the surgical management tactic of 145 patients with multiple trauma complicated by ARDS. All patients were treated in Ivano-Frankivsk Regional Clinical Hospital between 2007 and 2012. There were 118 (81.4%) males and 27 (18.6%) females. Patients were divided into two age groups. Group I consisted of 113 (78%) patients aged 18-64 years, including 106 (94%) males and 7 (6%) females. Group II consisted of 32 (22%) patients over 65 years old, with 7 (21.8%) males and 25 (78.2%) females. AISS-NISS (Abbreviated Injury Severity Score - New Injury Severity Score) scores were 55.9±1.312 in Group I and 54.9±2.43 in Group II.

RESULTS

The difference in emergency surgery timing between Group I and II was not significant (p>0.05). Age was an important criterion in defining optimal time of osteosynthesis (p<0.01). The choice of osteosynthesis type did not depend on patient age in the early period of trauma (1-3 days) (p>0.05), but the surgical tactic was significantly different in the late period (8 days and more) (p<0.01). Active fracture management with a stable osteosynthesis technique (intramedullary nailing, plating and external fixation) was preferred in the younger age group.

CONCLUSIONS

1. The age of the patient is quite an important factor defining the surgical tactic. 2. However, neither age nor severity of injury to the anatomical segments is a reliable criterion for assessing the severity of a patient's condition.