TY - JOUR
T1 - Early major fracture care in polytrauma—priorities in the context of concomitant injuries
T2 - A Delphi consensus process and systematic review
AU - Pfeifer, Roman
AU - Karl-Ludwig Klingebiel, Felix
AU - Balogh, Zsolt J.
AU - Beeres, Frank J.P.
AU - Coimbra, Raul
AU - Fang, Christian
AU - Giannoudis, Peter V.
AU - Hietbrink, Falco
AU - Hildebrand, Frank
AU - Kurihara, Hayato
AU - Lustenberger, Thomas
AU - Marzi, Ingo
AU - Oertel, Markus F.
AU - Peralta, Ruben
AU - Rajasekaran, Shanmuganathan
AU - Schemitsch, Emil H.
AU - Vallier, Heather A.
AU - Zelle, Boris A.
AU - Kalbas, Yannik
AU - Pape, Hans Christoph
N1 - Publisher Copyright:
Copyright © 2024 American Association for the Surgery of Trauma.
PY - 2024/10/1
Y1 - 2024/10/1
N2 - BACKGROUND: The timing of major fracture care in polytrauma patients has a relevant impact on outcomes. Yet, standardized treatment strategies with respect to concomitant injuries are rare. This study aims to provide expert recommendations regarding the timing of major fracture care in the presence of concomitant injuries to the brain, thorax, abdomen, spine/spinal cord, and vasculature, as well as multiple fractures. METHODS: This study used the Delphi method supported by a systematic review. The review was conducted in the Medline and EMBASE databases to identify relevant literature on the timing of fracture care for patients with the aforementioned injury patterns. Then, consensus statements were developed by 17 international multidisciplinary experts based on the available evidence. The statements underwent repeated adjustments in online- and in-person meetings and were finally voted on. An agreement of ≥75% was set as the threshold for consensus. The level of evidence of the identified publications was rated using the GRADE approach. RESULTS: A total of 12,476 publications were identified, and 73 were included. The majority of publications recommended early surgery (47/ 73). The threshold for early surgery was set within 24 hours in 45 publications. The expert panel developed 20 consensus statements and consensus >90% was achieved for all, with 15 reaching 100%. These statements define conditions and exceptions for early definitive fracture care in the presence of traumatic brain injury (n = 5), abdominal trauma (n = 4), thoracic trauma (n = 3), multiple extremity fractures (n = 3), spinal (cord) injuries (n = 3), and vascular injuries (n = 2). CONCLUSION: A total of 20 statements were developed on the timing of fracture fixation in patients with associated injuries. All statements agree that major fracture care should be initiated within 24 hours of admission and completed within that timeframe unless the clinical status or severe associated issues prevent the patient from going to the operating room.
AB - BACKGROUND: The timing of major fracture care in polytrauma patients has a relevant impact on outcomes. Yet, standardized treatment strategies with respect to concomitant injuries are rare. This study aims to provide expert recommendations regarding the timing of major fracture care in the presence of concomitant injuries to the brain, thorax, abdomen, spine/spinal cord, and vasculature, as well as multiple fractures. METHODS: This study used the Delphi method supported by a systematic review. The review was conducted in the Medline and EMBASE databases to identify relevant literature on the timing of fracture care for patients with the aforementioned injury patterns. Then, consensus statements were developed by 17 international multidisciplinary experts based on the available evidence. The statements underwent repeated adjustments in online- and in-person meetings and were finally voted on. An agreement of ≥75% was set as the threshold for consensus. The level of evidence of the identified publications was rated using the GRADE approach. RESULTS: A total of 12,476 publications were identified, and 73 were included. The majority of publications recommended early surgery (47/ 73). The threshold for early surgery was set within 24 hours in 45 publications. The expert panel developed 20 consensus statements and consensus >90% was achieved for all, with 15 reaching 100%. These statements define conditions and exceptions for early definitive fracture care in the presence of traumatic brain injury (n = 5), abdominal trauma (n = 4), thoracic trauma (n = 3), multiple extremity fractures (n = 3), spinal (cord) injuries (n = 3), and vascular injuries (n = 2). CONCLUSION: A total of 20 statements were developed on the timing of fracture fixation in patients with associated injuries. All statements agree that major fracture care should be initiated within 24 hours of admission and completed within that timeframe unless the clinical status or severe associated issues prevent the patient from going to the operating room.
KW - consensus statement
KW - definitive fracture fixation
KW - Delphi consensus
KW - Polytrauma
KW - timing of surgery
UR - http://www.scopus.com/inward/record.url?scp=85200831549&partnerID=8YFLogxK
U2 - 10.1097/TA.0000000000004428
DO - 10.1097/TA.0000000000004428
M3 - Article
C2 - 39085995
AN - SCOPUS:85200831549
SN - 2163-0755
VL - 97
SP - 639
EP - 650
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 4
ER -