Epidemiology of open tibia fractures in a population-based database: update on current risk factors and clinical implications.
Accidental Falls
/ statistics & numerical data
Accidents, Traffic
/ statistics & numerical data
Adolescent
Adult
Aged
Bicycling
/ injuries
Blood Transfusion
/ statistics & numerical data
Female
Fluid Therapy
/ statistics & numerical data
Fracture Fixation
/ statistics & numerical data
Fractures, Closed
/ epidemiology
Fractures, Open
/ epidemiology
Germany
/ epidemiology
Humans
Injury Severity Score
Length of Stay
Male
Middle Aged
Multiple Trauma
/ epidemiology
Pedestrians
/ statistics & numerical data
Risk Factors
Shock, Hemorrhagic
/ epidemiology
Tibial Fractures
/ epidemiology
Young Adult
Complications
Open long bone fracture
Polytrauma
Tibia
Trauma registry
Journal
European journal of trauma and emergency surgery : official publication of the European Trauma Society
ISSN: 1863-9941
Titre abrégé: Eur J Trauma Emerg Surg
Pays: Germany
ID NLM: 101313350
Informations de publication
Date de publication:
Jun 2019
Jun 2019
Historique:
received:
14
09
2017
accepted:
31
01
2018
pubmed:
6
2
2018
medline:
4
1
2020
entrez:
4
2
2018
Statut:
ppublish
Résumé
Open tibia fractures usually occur in high-energy mechanisms and are commonly associated with multiple traumas. The purposes of this study were to define the epidemiology of open tibia fractures in severely injured patients and to evaluate risk factors for major complications. A cohort from a nationwide population-based prospective database was analyzed (TraumaRegister DGU Out of 148.498 registered patients between 1/2002 and 12/2013; a total of 4.940 met the inclusion criteria (mean age 46.2 ± 19.4 years, ISS 30.4 ± 12.6 points). The CTF group included 2000 patients (40.5%), whereas 2940 patients (59.5%) sustained open tibia fractures (I°: 49.3%, II°: 27.5%, III°: 23.2%). High-energy trauma was the leading mechanism in case of open fractures. Despite comparable ISS and NISS values in patients with closed and open tibia fractures, open fractures were significantly associated with higher volume resuscitation (p < 0.001), more blood (p < 0.001), and mass transfusions (p = 0.006). While the rate of external fixation increased with the severity of soft tissue injury (37.6 to 76.5%), no major effect on mortality and other major complications was observed. Open tibia fractures are common in multiple trauma patients and are therefore associated with increased resuscitation requirements, more surgical procedures and increased in-hospital length of stay. However, increased systemic complications are not observed if a soft tissue adapted surgical protocol is applied.
Sections du résumé
BACKGROUND
BACKGROUND
Open tibia fractures usually occur in high-energy mechanisms and are commonly associated with multiple traumas. The purposes of this study were to define the epidemiology of open tibia fractures in severely injured patients and to evaluate risk factors for major complications.
METHODS
METHODS
A cohort from a nationwide population-based prospective database was analyzed (TraumaRegister DGU
RESULTS
RESULTS
Out of 148.498 registered patients between 1/2002 and 12/2013; a total of 4.940 met the inclusion criteria (mean age 46.2 ± 19.4 years, ISS 30.4 ± 12.6 points). The CTF group included 2000 patients (40.5%), whereas 2940 patients (59.5%) sustained open tibia fractures (I°: 49.3%, II°: 27.5%, III°: 23.2%). High-energy trauma was the leading mechanism in case of open fractures. Despite comparable ISS and NISS values in patients with closed and open tibia fractures, open fractures were significantly associated with higher volume resuscitation (p < 0.001), more blood (p < 0.001), and mass transfusions (p = 0.006). While the rate of external fixation increased with the severity of soft tissue injury (37.6 to 76.5%), no major effect on mortality and other major complications was observed.
CONCLUSION
CONCLUSIONS
Open tibia fractures are common in multiple trauma patients and are therefore associated with increased resuscitation requirements, more surgical procedures and increased in-hospital length of stay. However, increased systemic complications are not observed if a soft tissue adapted surgical protocol is applied.
Identifiants
pubmed: 29396757
doi: 10.1007/s00068-018-0916-9
pii: 10.1007/s00068-018-0916-9
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
445-453Références
Injury. 1998 Sep;29(7):529-34
pubmed: 10193496
J Trauma. 1999 Aug;47(2):309-23
pubmed: 10452467
J Trauma. 2000 Apr;48(4):613-21; discussion 621-3
pubmed: 10780592
J Bone Joint Surg Am. 2002 Jun;84(6):971-80
pubmed: 12063331
J Bone Joint Surg Am. 2003 Mar;85(3):571; author reply 571-2
pubmed: 12637451
Chest. 1992 Jun;101(6):1644-55
pubmed: 1303622
J Trauma. 2006 Jun;60(6):1228-36; discussion 1236-7
pubmed: 16766965
J Bone Joint Surg Br. 2006 Oct;88(10):1351-60
pubmed: 17012427
J Bone Joint Surg Am. 2006 Dec;88(12):2739-48
pubmed: 17142427
J Bone Joint Surg Am. 2007 May;89(5):923-8
pubmed: 17473126
J Bone Joint Surg Am. 2007 Aug;89(8):1685-92
pubmed: 17671005
Crit Care Med. 1991 Jul;19(7):973-6
pubmed: 1824030
J Orthop Trauma. 2007 Nov-Dec;21(10 Suppl):S1-133
pubmed: 18277234
Acta Orthop. 2008 Aug;79(4):526-33
pubmed: 18766487
Vox Sang. 2011 Feb;100(2):231-8
pubmed: 20735809
Ann R Coll Surg Engl. 2010 Nov;92(8):693-6
pubmed: 21047449
Injury. 2011 Dec;42(12):1408-15
pubmed: 22019355
Injury. 2012 Jun;43(6):891-7
pubmed: 22204774
Bone Joint J. 2013 Jan;95-B(1):101-5
pubmed: 23307681
Clin Orthop Relat Res. 2013 Sep;471(9):2815-21
pubmed: 23479238
J Orthop Trauma. 2014 Nov;28(11):626-31
pubmed: 24553413
Bone Joint J. 2014 Oct;96-B(10):1370-7
pubmed: 25274924
Curr Opin Crit Care. 2014 Dec;20(6):620-5
pubmed: 25290911
Injury. 2015 Apr;46(4):740-5
pubmed: 25583638
Ann R Coll Surg Engl. 2015 Sep;97(6):469-75
pubmed: 26274742
Injury. 2015 Sep;46 Suppl 3:S13-8
pubmed: 26458293
J Orthop Trauma. 2016 Mar;30(3):104-12
pubmed: 26606600
Eur J Trauma Emerg Surg. 2009 Oct;35(5):437-47
pubmed: 26815209
J Orthop Trauma. 2016 Jul;30(7):377-80
pubmed: 26825491
Strategies Trauma Limb Reconstr. 2016 Apr;11(1):1-4
pubmed: 26920713
Bone Joint J. 2016 Mar;98-B(3):420-4
pubmed: 26920970
J Clin Diagn Res. 2016 Feb;10(2):RC10-4
pubmed: 27042541
Injury. 2016 Apr;47(4):787-91
pubmed: 27090109
Unfallchirurg. 2016 May;119(5):374-87
pubmed: 27160729
J Trauma Acute Care Surg. 2016 Nov;81(5):824-833
pubmed: 27533903
J Trauma. 1988 Aug;28(8):1270-3
pubmed: 3137367
J Trauma. 1985 Jan;25(1):60-4
pubmed: 3965737
J Trauma. 1974 Mar;14(3):187-96
pubmed: 4814394
J Trauma. 1984 Aug;24(8):742-6
pubmed: 6471139
Instr Course Lect. 1982;31:75-87
pubmed: 7175186
J Trauma. 1995 Jul;39(1):12-22
pubmed: 7636902
J Bone Joint Surg Am. 1976 Jun;58(4):453-8
pubmed: 773941
J Bone Joint Surg Am. 1994 Aug;76(8):1162-6
pubmed: 8056796
J Bone Joint Surg Br. 1994 Jan;76(1):13-9
pubmed: 8300656
J Orthop Trauma. 1993;7(4):357-60
pubmed: 8377047
AORN J. 1996 May;63(5):875-81, 885-96; quiz 899-906
pubmed: 8712809
J Trauma. 1997 Dec;43(6):922-5; discussion 925-6
pubmed: 9420106
Clin Orthop Relat Res. 1998 May;(350):18-25
pubmed: 9602796
Crit Care Med. 1998 Nov;26(11):1793-800
pubmed: 9824069