The long-term outcome of high-energy fractures treated at emergency medical center

• Published in: Nihon Kyukyu Igakukai Zasshi 2013/12/15, Vol.24(12), pp.991-999
• Main Authors: Suzuki, Takashi, Matsuura, Terumasa, Kawamura, Tadashi, Minehara, Masaaki, Kitahara, Takao, Soma, Kazui
• Format: Article
• Language: eng ; jpn
• Subjects: delayed union; extremity trauma; functional outcome; nonunion; surgical site infection
• ISSN: 0915-924X; 1883-3772
• DOI: 10.3893/jjaam.24.991

Emergency medical centers play important roles in treating high-energy trauma patients with extremity fractures. However, there have been no reports on the long-term outcome of fractures internally fixated at emergency medical centers in Japan. The purpose of this study was to show the rates of bone union and unexpected re-operations, and to evaluate the risk factors for re-operations. A total of 272 patients with 363 extremity fractures were retrospectively reviewed. Age, mechanism of injury, injury severity score, fracture site, presence of open fracture, and follow-up data were collected using an electronic medical records system. Patients who were followed up at other institutions were investigated by sending letters to the respective orthopaedic directors. The median age of the patients was 37 years old. Mechanisms of injury, in decreasing order, were motorcycle accident, fall from a height, and automobile accident. The most frequent fracture site was femoral shaft followed by tibial shaft. Open fracture was observed in 39.4% of all the fractures. Long-term outcome was shown in 324 fractures (89.3%) with a median follow-up of 19 months. Of those, 90 fractures required unexpected re-operations at a median after internal fixation time of 112 days. The reasons for re-operation were surgical site infection, nonunion, and delayed union in decreasing order. In total, 313 fractures (96.6%) achieved good bone union; however, there were several fractures that were refractory, e.g., arthrodesis in 4, amputation in 3, nonunion in 2, joint replacement in 1, and chronic osteomyelitis in 1. Logistic regression analysis revealed that open fracture, lower extremity fracture, and fractures in multiple trauma patients were statistically significant risk factors for re-operations. In summary, high-energy fractures, especially those with open wounds, located in the lower extremities, or multiple trauma patients tend to have a significant possibility of requiring unexpected re-operations and should be followed up meticulously after internal fixation.