Abstract
Purpose of study:
In polytrauma patients (ISS > 16) early long bone and pelvic fracture fixation (< 24 hours post injury) has been shown to be beneficial. Surgery in the presence of subclinical hypo perfusion (SCH) (normal vital signs with a serum lactate > 2.5 mmol/L) may be detrimental. This study aimed to investigate the effect of fracture fixation in polytrauma patients with SCH.
Description of methods:
We performed a retrospective database review of polytrauma patients (ISS > 16) with significant long bone or pelvic fractures (extremity NISS> 9) who underwent surgical fracture stabilisation within 48 hours of injury. In the group of patients with normal vital signs (mean arterial pressure (MAP) > 60 mmHg and heart rate (HR) < 110 beats/min) we compared outcomes of those with normal lactate (< 2.5 mmol/L) prior to surgery with patients that had a raised lactate (> 2.5 mmol/L).
Results:
Of the 36 patients with normal preoperative vital signs, 17 had normal serum lactates (control group) and 19 abnormal (SCH group). The SCH group required more inotropes in the first 24 hours post-surgery (p=0.02), had higher Sequential Organ Failure Assessment (SOFA) scores on day three (p=0.003) and showed a trend towards higher SOFA scores on day seven (p=0.061).
Conclusion:
Early fracture fixation in patients with SCH as evidenced by a lactate > 2.5 mmol/L is associated with worse postoperative outcomes. Consideration should be given to delaying surgery in this cohort until resuscitation is complete.
