gms | German Medical Science

Introduction: Since 1970s the incidence, number and severity of extremity injuries constantly decreased. Open limb fractures itself are rarely life-threatening injuries, but are associated with increased risk of infection leading to systemic inflammatory response syndrome, sepsis and multiple organ failure.

In this study we systematically recorded the incidence of open fractures (OF) with/-out polytrauma concerning the incidence, fracture type, concomitant soft tissue injury and investigated the influence of OF in polytraumatized patients according to their impact on the clinical course compared to polytraumatized patients without OF.

Material and methods: We collected the data of all OF treated 2010 at our trauma center (epidemiology OF) and data from 763 polytraumatized patients treated from 2001-2009 (comparison polytrauma ± OF). Patients with open skull fractures were excluded. Gender, age, injury type, anatomical location, ISS, transfusion requirement, hospitalization time and duration of ventilator support were documented and statistically analysed by PASW19.0 (p<0.05, Wilcoxon/Mann-Whitney Test).

Results: 1% (n=174) of 18.048 trauma victims treated 2010 in the emergency department of our trauma center presented with OF (age 43.2±19.4 years; 71.3% male) compared to a 12.9% incidence in polytraumatized patients. The predominantly injured anatomical body regions were hand, midface and lower leg compared to lower limb injuries (femur, tibia) in polytraumatized patients. Furthermore, polytraumatized patients suffered higher degrees of soft tissue injuries and had a higher incidence of traumatic amputations compared to the general trauma patient. Polytraumatized patients with OF had significantly higher ISS, AIS head, AIS extremity, transfusion requirement, incidence of mass transfusion, longer ventilator support, critical care treatment and hospitalization compared to polytrauma patients without

Conclusion: OF are rare injuries but occurred 12-fold more often in the polytraumatized patient. Furthermore, OF in polytrauma are associated with prolonged critical care treatment and hospitalization based on an increased complication rate.

Concluding, OF and polytrauma is a dangerous combination in trauma patients with concomitant higher injury severity indicating the necessity of damage control surgery principles.