Julia Dormann, Klemens Horst, Karolina Dahms, Eva Steinfeld, Kelly Ansems, Heidrun Janka, Maria-Inti Metzendorf, Thomas Breuer, Carina Benstoem, Frank Hildebrand, Eftychios Bolierakis
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Systematic reviews, randomized control trials (RCTs) and observational studies comparing early (< 24 h) versus late (> 24 h) definitive operative stabilization in adult polytrauma patients admitted to the ICU were included.</p><p><strong>Results: </strong>Since no systematic reviews and RCTs were available on this subject, one observational study was identified, including a total of 418 polytrauma patients (n<sub>early</sub> = 165, n<sub>late</sub> = 253), median age: 40.3 years (early 40.1 years, late 40.4 years). Early definitive stabilization was associated with a decreased risk of acute respiratory distress syndrome (ARDS) compared to late stabilization of unstable pelvis and acetabulum fractures (RR 0.38, 95% CI 0.18-0.81; RD 78 fewer per 1000, 95% CI 104 fewer to 24 fewer; 1 study, 418 participants; very low certainty of evidence). Furthermore, early definitive stabilization may decrease the risk of pneumonia compared to late stabilization of unstable pelvis and acetabulum fractures (RR 0.50, 95% CI 0.28-0.88; RD 85 fewer per 1000, 95% CI 122 fewer to 20 fewer); 1 study, 418 participants; very low certainty of evidence).</p><p><strong>Conclusion: </strong>There is limited evidence regarding early definitive fracture repair (≤ 24 h) compared to late repair of pelvic fractures in polytrauma patients. One observational study showed a reduced incidence of septic respiratory complications, ARDS, and multi-organ failure (MOF) in polytrauma patients who received early definitive fracture repair.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"100"},"PeriodicalIF":1.9000,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11805852/pdf/","citationCount":"0","resultStr":"{\"title\":\"The optimal timing for definitive operative stabilization of pelvic fractures in polytrauma patients: effects on clinical outcomes - a systematic review.\",\"authors\":\"Julia Dormann, Klemens Horst, Karolina Dahms, Eva Steinfeld, Kelly Ansems, Heidrun Janka, Maria-Inti Metzendorf, Thomas Breuer, Carina Benstoem, Frank Hildebrand, Eftychios Bolierakis\",\"doi\":\"10.1007/s00068-025-02774-1\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>The optimal timing for definitive surgical treatment of pelvic fractures in polytrauma patients remains a topic of ongoing discussion due to the complexity of these injuries. 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One observational study showed a reduced incidence of septic respiratory complications, ARDS, and multi-organ failure (MOF) in polytrauma patients who received early definitive fracture repair.</p>\",\"PeriodicalId\":12064,\"journal\":{\"name\":\"European Journal of Trauma and Emergency Surgery\",\"volume\":\"51 1\",\"pages\":\"100\"},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2025-02-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11805852/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Journal of Trauma and Emergency Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s00068-025-02774-1\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"EMERGENCY MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Trauma and Emergency Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00068-025-02774-1","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"EMERGENCY MEDICINE","Score":null,"Total":0}
引用次数: 0
摘要
目的：由于多创伤患者骨盆骨折的复杂性，骨盆骨折最终手术治疗的最佳时机仍然是一个持续讨论的话题。因此，本分析旨在系统地比较早期和晚期骨盆骨折手术稳定对多发创伤患者预后的影响。方法：系统检索PubMed、CENTRAL和Web of Science，确定从每个数据库建立到2023年3月13日的相关已完成和正在进行的研究。系统评价、随机对照试验（rct）和观察性研究比较了ICU收治的成人多发外伤患者早期（24小时）明确的手术稳定。结果：由于没有关于该主题的系统评价和随机对照试验，我们确定了一项观察性研究，共纳入418例多发创伤患者（近165例，晚期253例），中位年龄：40.3岁（早期40.1岁，晚期40.4岁）。与不稳定骨盆和髋臼骨折的晚期稳定相比，早期稳定与急性呼吸窘迫综合征（ARDS）的风险降低相关(RR 0.38, 95% CI 0.18-0.81；RD减少78 / 1000,95% CI减少104 ~ 24；1项研究，418名参与者；证据的确定性非常低)。此外，与不稳定骨盆和髋臼骨折的晚期稳定相比，早期稳定可能降低肺炎的风险(RR 0.50, 95% CI 0.28-0.88；RD减少85 / 1000,95% CI减少122 - 20)；1项研究，418名参与者；证据的确定性非常低)。结论：与盆腔多伤患者骨盆骨折晚期修复相比，早期明确骨折修复（≤24小时）的证据有限。一项观察性研究显示，在早期接受明确骨折修复的多发创伤患者中，脓毒性呼吸系统并发症、ARDS和多器官衰竭（MOF）的发生率降低。
The optimal timing for definitive operative stabilization of pelvic fractures in polytrauma patients: effects on clinical outcomes - a systematic review.
Purpose: The optimal timing for definitive surgical treatment of pelvic fractures in polytrauma patients remains a topic of ongoing discussion due to the complexity of these injuries. This analysis therefore aims to systematically compare early versus late definitive operative stabilization of pelvic fractures on outcome in polytrauma patients.
Methods: PubMed, CENTRAL and Web of Science were systematically searched to identify relevant completed and ongoing studies from the inception of each database to March 13, 2023. Systematic reviews, randomized control trials (RCTs) and observational studies comparing early (< 24 h) versus late (> 24 h) definitive operative stabilization in adult polytrauma patients admitted to the ICU were included.
Results: Since no systematic reviews and RCTs were available on this subject, one observational study was identified, including a total of 418 polytrauma patients (nearly = 165, nlate = 253), median age: 40.3 years (early 40.1 years, late 40.4 years). Early definitive stabilization was associated with a decreased risk of acute respiratory distress syndrome (ARDS) compared to late stabilization of unstable pelvis and acetabulum fractures (RR 0.38, 95% CI 0.18-0.81; RD 78 fewer per 1000, 95% CI 104 fewer to 24 fewer; 1 study, 418 participants; very low certainty of evidence). Furthermore, early definitive stabilization may decrease the risk of pneumonia compared to late stabilization of unstable pelvis and acetabulum fractures (RR 0.50, 95% CI 0.28-0.88; RD 85 fewer per 1000, 95% CI 122 fewer to 20 fewer); 1 study, 418 participants; very low certainty of evidence).
Conclusion: There is limited evidence regarding early definitive fracture repair (≤ 24 h) compared to late repair of pelvic fractures in polytrauma patients. One observational study showed a reduced incidence of septic respiratory complications, ARDS, and multi-organ failure (MOF) in polytrauma patients who received early definitive fracture repair.
期刊介绍：
The European Journal of Trauma and Emergency Surgery aims to open an interdisciplinary forum that allows for the scientific exchange between basic and clinical science related to pathophysiology, diagnostics and treatment of traumatized patients. The journal covers all aspects of clinical management, operative treatment and related research of traumatic injuries.
Clinical and experimental papers on issues relevant for the improvement of trauma care are published. Reviews, original articles, short communications and letters allow the appropriate presentation of major and minor topics.
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