Institutional members access full text with Ovid®

The impact of major operative fractures in blunt abdominal injury

Nahm, Nickolas J. MD; Como, John J. MD, MPH; Vallier, Heather A. MD

Journal of Trauma and Acute Care Surgery: May 2013 - Volume 74 - Issue 5 - p 1307–1314
doi: 10.1097/TA.0b013e31828c3f59
Original Articles

BACKGROUND: Abdominal injury has been shown to be an independent risk factor for pulmonary complications in patients with extremity injuries. We propose to characterize orthopedic patients with severe abdominal trauma. We hypothesize that operative fractures of the thoracolumbar spine, pelvis, acetabulum, or femur increase systemic complications in patients with blunt abdominal injury.

METHODS: A retrospective review of patients presenting to a Level I trauma center with abdominal injury between 2000 and 2006 was performed. Adult patients between the ages of 18 years and 65 years with high-energy, blunt trauma resulting in severe abdominal injury (abdomen Abbreviated Injury Scale [AIS] score ≥ 3) and Injury Severity Score (ISS) of 18 or greater were included. Patients were divided into two comparison groups as follows: the fracture group had operative fractures of the pelvis, acetabulum, thoracolumbar spine, and/or femur, and the control group did not sustain these fractures of interest. Systemic complications were documented. Unadjusted and multivariable logistic regression analyses were performed.

RESULTS: The control group included 91 patients, and the fracture group included 106 patients with 136 fractures of interest. With unadjusted analysis, the fracture group had more complications (34% [36 of 106] vs. 18% [16 of 91], p = 0.010), including adult respiratory distress syndrome (8% [8 of 106] vs. 1% [1 of 91], p = 0.040), and sepsis (11% [12 of 106] vs. 3% [3 of 91], p = 0.056). Logistic regression modeling demonstrates that the presence of an operative fracture increased the odds of developing at least one complication approximately three times (odds ratio, 2.88, p = 0.006), after controlling for presence of chest injury and type of injured abdominal organ.

CONCLUSION: Operative fractures of the thoracolumbar spine, pelvis, acetabulum and femur increase the risk of developing systemic complications in patients with blunt abdominal injury. Further study is necessary to optimize treatment protocols for these high-risk patients.

LEVEL OF EVIDENCE: Prognostic study, level III.

From the Department of Orthopaedic Surgery (N.J.N., H.A.V.), and Division of Trauma, Critical Care, and Burns (J.J.C.), Department of Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.

Submitted: September 6, 2012, Revised: December 13, 2012, Accepted: December 18, 2012.

This study was presented as a poster at the Orthopaedic Trauma Association 28th Annual Meeting, on October 3–6, 2012, in Minneapolis, Minnesota.

Address for reprints: Heather A. Vallier, MD, Department of Orthopaedic Surgery, MetroHealth Medical Center, Cleveland, OH, 2500 MetroHealth Dr, Cleveland, OH 44109; email: hvallier@metrohealth.org.

© 2013 Lippincott Williams & Wilkins, Inc.