Is early appropriate care of axial and femoral fractures appropriate in multiply-injured elderly trauma patients?

Abstract

Background: Previous work established resuscitation parameters that minimize complications with early fracture management. This Early Appropriate Care (EAC) protocol was applied to patients with advanced age to determine if they require unique parameters to mitigate complications. Methods: Between October 2010 and March 2013, 376 consecutive skeletally mature patients with unstable fractures of the pelvis, acetabulum, thoracolumbar spine, and/or proximal or diaphyseal femur fractures were treated at a level I trauma center and were prospectively studied. Patients aged ≤30years (n=114), 30 to 60years (n=184), and ≥60years (n=37) with Injury Severity Scores (ISS) ≥16 and unstable fractures of the pelvis, acetabulum, spine, and/or diaphyseal femur were treated within 36h, provided they showed evidence of adequate resuscitation. ISS, Glasgow Coma Scale (GCS), and American Society of Anesthesiologists (ASA) classification were determined. Lactate, pH, and base excess (BE) were measured at 8-h intervals. Complications included pneumonia, pulmonary embolism (PE), acute renal failure, acute respiratory distress syndrome (ARDS), multiple organ failure (MOF), deep vein thrombosis, infection, sepsis, and death. Results: Patients ≤30years old (y/o) were more likely to sustain gunshot wounds (p=0.039), while those ≥60y/o were more likely to fall from a height (p=0.002). Complications occurred at similar rates for patients ≤30y/o, 30 to 60y/o, and ≥60y/o. There were no differences in lactate, pH, or BE at the time of surgery. For patients ≤30y/o, there were increased overall complications if pH was <7.30 (p=0.042) or BE