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:2/5/2016)... Feb. 5, 2016  As people age, it is ... of recommended screenings and tests that are linked with ... However, for the majority of aging individuals, hearing health ... For the 37.5 million American adults who report some ... to make hearing health a 2016 healthy aging priority.[1] ...
(Date:2/5/2016)... Feb. 5, 2016  Venice,s newest laser clinic, ... first of its kind in the area and ... advanced laser treatment. The physician-owned and operated laser ... Suncoast by storm with its revitalizing skin care ... multi-wavelength Astanza Trinity technology. http://photos.prnewswire.com/prnh/20160204/329957 ...
(Date:2/5/2016)...  Henry Schein, Inc. (NASDAQ: HSIC ), the world,s ... office-based dental, animal health and medical practitioners, announced today ... a majority ownership interest in Dental Cremer S.A., a ... Brazil . --> ... the dental distribution business of Cremer S.A. With 2015 ...
Breaking Medicine Technology:
(Date:2/8/2016)... ... February 08, 2016 , ... Remember the old saying “rub some dirt on ... A~, author of “Calcium Bentonite Clay” the health benefits of integrating clay into a ... the body. , A former motivational speaker, Perry A~ has since dedicated her life ...
(Date:2/8/2016)... ... February 08, 2016 , ... The ... important news! AHCC and the Home Health and Hospice ICD-10 Transition Workgroup are ... official ICD coding guidance and clarifications, to address concerns over the use of ...
(Date:2/8/2016)... ... February 08, 2016 , ... According to research ... U.S. require dental technicians to be certified or obtain continuing education. To increase ... the “What’s In Your Mouth?” campaign to inform dentists and patients about the ...
(Date:2/6/2016)... ... February 06, 2016 , ... ... , MEDIA ADVISORY: 5000 PERIOPERATIVE NURSES EXPECTED AT AORN SURGICAL CONFERENCE & ... nurses in the world with an estimated 5000 perioperative nurses in attendance ...
(Date:2/5/2016)... ... ... Steven Tonkinson, 36, of Coconut Grove, Florida, ran the Miami Marathon on ... This year, he ran all 26.2 miles with a green 25-pound ShelterBox strapped to ... , This Sunday, while many are watching the Superbowl, Steven Tonkinson will strap on ...
Breaking Medicine News(10 mins):