股骨外支架FemurExFix.ppt

FEMORAL FRACTURES IN SEVERE OR MULTIPLE TRAUMA Intramedullary Nail or External Fixation . . . . or Traction and delayed fixation? Is Femoral Traction Harmful? Primary Operative Fixation of Long Bones in Patients with Multiple Injuries Riska et.al., Helsinki: J.Trauma, 17, 1977 Clinical Fat Embolism snowstorm infiltration of the CXR disturbance of consciousness hypoxia and fever petechial skin rash rapid respiration progressive anaemia multiple organ failure Riska Two Conclusions: Long bone fractures were a usual factor in the development of fat embolism Early operative fixation of long bone fractures seemed to prevent the development of clinical fat embolism Riska Is Early Operation Safe? 1969 - 74: prospective F.U. of 47 patients, after early fixation of femoral fractures: One 80 year old woman died Otherwise no complications as result of early surgery Early operation is a safe procedure Riska Early Surgery as Part of Polytrauma Management Early Osteosynthesis and Prophylactic Mechanical Ventilation in the Multitrauma Patient Goris et.al., Nijmegen, Holland: J.Trauma, 22, 1982 Current Practice in 1970’s Outlined the “classical” method of Wolff, Dittmann Rüedi: Resuscitation and support in 5 stages, with operative reconstruction of fractures at stage 4, often weeks after the injury Goris et. al . 1977 Results: Immediate Operative Fixation, and Mechanical Ventilation with PEEP: Decreased postoperative sepsis Decreased incidence of ARDS Decreased mortality Goris Blunt Multiple Trauma, Femur Traction and the Pulmonary Failure Septic State (PFSS) A prospective study: treatment selected by surgeon; groups strictly controlled thereafter. Compared with immediate fixation of femoral fractures ( 24 hours) . . . Seible et.al., Buffalo, NY: Ann. Surg. 202, 1985 10 days of traction prior to surgery: Duration of PFSS x 2 Cost of care x 2 Fracture complications x 4 All figures significant Seible et. al. 1985 30 days of traction prior to surgery: PFSS x