Department of Orthopaedic Surgery, University of Louisville, University of Louisville School of Medicine, 550 South Jackson Street 1st Floor Ambulatory Care Building, Louisville, KY, 40292, USA.
Department of Orthopaedic Surgery, University of Missouri, University of Missouri School of Medicine, Columbia, USA.
Eur J Orthop Surg Traumatol. 2023 Jul;33(5):1727-1734. doi: 10.1007/s00590-022-03340-w. Epub 2022 Aug 6.
The optimal timing to definitive osteosynthesis in the polytraumatized patient remains an unanswered question. Early total care, damage control orthopaedics, and early appropriate care have been described to manage the fractures in these patients, but there is a paucity of literature specific to ipsilateral tibial and femoral fractures. We sought the perioperative outcomes of primary simultaneous intramedullary nailing (IMN) versus temporizing external fixation (EF) of both fractures.
A chart review of all patients who sustained fractures of the ipsilateral femur and tibia that were definitively treated with (IMN) from January 2010 to December 2020 was performed. Patients who underwent initial EF and those that were primarily treated with IMNs were examined.
IMNs and EF were the initial treatment in 23 and 16 patients, respectively. The mean (range) injury severity score (ISS) was 23.3 (33) in the EF group vs. 18.5 (34) in the IMN group, (p = 0.0686). The EF group had a higher total transfused units of packed red blood cells 7.4 vs. 2.8, the mean initial operative time was 236 vs. 282.6 (min), (p = 0.7399), a longer mean total operative time 601.78 vs. 236 (min), and longer mean length of stay 15.6 vs. 11 (days), (p < 0.5). Rates of complications were not significantly different between groups.
Primary IMN is as safe as provisional EF in the adequately resuscitated patient with ipsilateral femoral and tibial fractures. This implies the fixation of both fractures into a single surgery without increasing perioperative complications, and decreasing total hospital stay in patients with sufficient preoperative resuscitation.
多发伤患者确定性骨接合的最佳时机仍是一个悬而未决的问题。早期全面治疗、损伤控制矫形和早期适当治疗已被用于治疗这些患者的骨折，但针对同侧胫骨和股骨骨折的文献相对较少。我们研究了同侧股骨和胫骨骨折患者的围手术期结果，这些患者接受了初始髓内钉（IMN）固定或临时外固定（EF）治疗。
对 2010 年 1 月至 2020 年 12 月期间采用（IMN）确定性治疗的同侧股骨和胫骨骨折患者进行了图表回顾。检查了接受初始 EF 治疗和初始 IMN 治疗的患者。
EF 和 IMN 分别是 23 例和 16 例患者的初始治疗方法。EF 组的损伤严重程度评分（ISS）均值（范围）为 23.3（33），而 IMN 组为 18.5（34），（p=0.0686）。EF 组的总输血量（浓缩红细胞）更高，为 7.4 单位，而 IMN 组为 2.8 单位，初始手术时间均值为 236 分钟，而 IMN 组为 282.6 分钟，（p=0.7399），总手术时间均值更长，为 601.78 分钟，而 IMN 组为 236 分钟，住院时间均值更长，为 15.6 天，而 IMN 组为 11 天，（p<0.5）。两组并发症发生率无显著差异。
在同侧股骨和胫骨骨折且充分复苏的患者中，初始 IMN 与临时 EF 同样安全。这意味着在充分的术前复苏的患者中，将两种骨折固定到单一手术中，不会增加围手术期并发症，并减少总住院时间。
