Navigation Links
Trauma 411: Prolonged Surgery Should be Avoided in Certain Cases
Date:9/1/2009

Timing is what matters in treating orthopaedic injuries in trauma patients

ROSEMONT, Ill., Sept. 1 /PRNewswire-USNewswire/ -- Trauma patients who sustain multiple fractures are often in serious condition when they arrive at the emergency department. A review article published in the September 2009 issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS) explains that trauma patients who have several orthopaedic injuries and are considered to be in unstable condition should only have a few hours of surgery when first arriving at the hospital. This principle is known as 'damage control'.

The benefits of initially limiting time in the operating room for patients with life-threatening injuries include:

  • less blood loss during surgery;
  • fewer complications in the intensive care unit;
  • less stimulation to the immune system; and
  • higher patient survival rates.

According to lead author Hans-Christoph Pape, MD, Chairman of Orthopaedic/Trauma Surgery at the University of Aachen in Aachen, Germany, data shows that too many surgeries and blood loss can weaken the immune system and can lead to a higher likelihood of experiencing complications after surgery."

"If a patient has just a couple of fractures it is of course useful to operate right away," says Dr. Pape. "However, if a patient has life-threatening injuries for example, more than three fractures and perhaps a lacerated liver, it is often too dangerous to do all the surgery right away."

In trauma patients with life-threatening injuries, Dr. Pape and his colleagues found:

  • It often is best to use an external fixator (where pins in the bone are connected by an external bar) to stabilize an orthopaedic injury to stop initial pain and bleeding.
  • Two or three days later, once the patient is stable, data suggests this period to be a more ideal time to begin other more invasive and time-consuming operations.

Pape and his colleagues analyzed data from several trauma registries in Germany. They compared patient outcomes in about 21,000 trauma patients with the amount of hours each patient had spent in the operating room.

"We found that patients with life-threatening injuries, such as chest contusions or liver lacerations in association to multiple bone fractures, and who have surgery for six or more hours do not always do as well," says Dr. Pape. "If you limit the amount of time in the operating room to less than three hours, patients appear to do better."

In the more severe cases, study authors say it is ideal to taper the amount of surgery. It is important to monitor blood pressure, pulmonary function and immune function to see if patients are stable enough to undergo further surgery.

The benefit of scheduling surgery to repair fractures over the span of several days is that it allows the trauma patient to recover from every surgical procedure before moving forward with the next one.

Timing is key in patients with life-threatening injuries. "There needs to be close communication between the orthopaedic surgeon, the general surgeon and ICU staff," says Dr. Pape. "All members of the care team need to re-evaluate the patient throughout the process to see if it is safe to fix the next fracture."

Disclosure: Hans-Christophe Pape, MD, has received nothing of value and does not hold stock in a commercial company or institution related directly or indirectly to the subject of this article.

AAOS

Orthopaedic Trauma Association

Fan AAOS on Facebook

Follow AAOS on Twitter


'/>"/>
SOURCE American Academy of Orthopaedic Surgeons
Copyright©2009 PR Newswire.
All rights reserved

Related medicine technology :

1. UNT Health Science Centers Groundbreaking Research Applied to Protecting Brain After Traumatic Injury
2. U.S. Naval Medical Research Center Proposed RESUS Clinical Trial in Trauma Patients Remains on FDA Hold
3. Glycerin Proven to Improve Bruising and Swelling Caused By Trauma to Skin
4. U.S. Naval Medical Research Center Resubmits IND Application for Proposed RESUS Clinical Trial in Trauma Patients in the Out-of-Hospital Setting
5. Neuro Kinetics: Research Suggests I-Portal(R) NOTC Data Shows Mild Traumatic Brain Injuries That Other Technologies Miss
6. For Iraq Veterans, Headaches Continue After Traumatic Brain Injury
7. U.S. Naval Medical Research Center Resubmits IND Application for Proposed Op RESUS Clinical Trial in Trauma Patients in the Battlefield Setting
8. U.S. Navy Submits Protocol for Field Trauma Trial of Hemopure(R)
9. Biopure Phase III Orthopedic Trial Results Published in Journal of Trauma
10. Mitchell, Military TBI Task Force Highlight the Importance of Traumatic Brain Injury Research; Mitchell Endorses Ground Breaking Traumatic Brain Injury Study
11. Researchers Report First Successful Treatment of Chronic Traumatic Brain Injury
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:2/22/2017)... NEW YORK , Feb. 22, 2017 /PRNewswire/ ... to the atherosclerosis partnering deals and agreements entered ... Read the full report: http://www.reportlinker.com/p03605675-summary/view-report.html ... since 2010 report provides understanding and access to ... world,s leading healthcare companies. - Trends ...
(Date:2/22/2017)... , Feb. 22, 2017 Summary ... partnering deals and agreements entered into by the worlds ... http://www.reportlinker.com/p03605682-summary/view-report.html Description The Global Motor Neurone Disease ... and access to partnering deals and agreements entered into ... Trends in partnering deals - Top deals by ...
(Date:2/22/2017)... 22, 2017 The top ... are Olympus Corporation, Nikon Corporation, and Leica Microsystems. ... in the overall market in 2015. The oligopolistic ... through result-oriented research and development activities and mergers ... focus on expanding their business to emerging economies ...
Breaking Medicine Technology:
(Date:2/22/2017)... ... February 22, 2017 , ... Pet obesity in the U.S. continued ... according to the Association for Pet Obesity Prevention (APOP). During the ninth annual survey, ... such as the benefits of corn and grains, value of raw and organic diets, ...
(Date:2/22/2017)... ... February 22, 2017 , ... FPS is a ... PTSD. , Established in 1977, our organization was at the forefront in working ... to civilian life were evident and served as the catalyst for the establishing ...
(Date:2/22/2017)... ... 22, 2017 , ... In today’s world, homeowners face a ... market, it is easy to start feeling frustrated and confused. To help Dallas ... security consultation. , Home Security Hardware Choices, There are innumerable choices for home ...
(Date:2/22/2017)... ... February 22, 2017 , ... ... itself - the Vector™ Series Multi-Cook Oven offers up to four ovens in ... exclusive Structured Air Technology™ for unmatched evenness in cooking. Alto-Shaam has partnered with ...
(Date:2/22/2017)... BAY AREA - NORTHERN CALIFORNIA (PRWEB) , ... ... ... aims to expand the pipeline and the number of African American/Black students ... encourages medical students and residents to pursue their careers as physicians in the ...
Breaking Medicine News(10 mins):