Standards of fracture care in polytrauma: results of a Europe-wide survey by the ESTES polytrauma section

Julian Scherer; Raul Coimbra; Diego Mariani; Luke Leenen; Radko Komadina; Ruben Peralta; Luka Fattori; Ingo Marzi; Klaus Wendt; Christine Gaarder; Hans-Christoph Pape; Roman Pfeifer

doi:10.1007/s00068-022-02126-3

Standards of fracture care in polytrauma: results of a Europe-wide survey by the ESTES polytrauma section

Eur J Trauma Emerg Surg. 2022 Oct 13. doi: 10.1007/s00068-022-02126-3. Online ahead of print.

Authors

Julian Scherer¹, Raul Coimbra², Diego Mariani³, Luke Leenen⁴, Radko Komadina⁵, Ruben Peralta⁶, Luka Fattori⁷, Ingo Marzi⁸, Klaus Wendt⁹, Christine Gaarder¹⁰, Hans-Christoph Pape¹¹, Roman Pfeifer¹¹

Affiliations

¹ Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Raemistr. 100, 8091, Zurich, Switzerland. julian.scherer@usz.ch.
² Riverside University Health System and Loma Linda University, Riverside, CA, USA.
³ Department of Emergency General Surgery, Legnano Hospital, ASST Ovest Milanese, Legnano, MI, Italy.
⁴ Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
⁵ Department of Traumatology, General and Teaching Hospital Celje, Medical Faculty Ljubljana University, 3000, Celje, Slovenia.
⁶ Surgical Department (Hamad General Hospital), Hamad Medical Corporation, HMC, Doha, Qatar.
⁷ Department of Surgery, San Gerardo Hospital, University of Milan Bicocca, G.B. Pergolesi 33, Monza, Italy.
⁸ Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany.
⁹ Department of Trauma Surgery, University Medical Center Groningen (UMCG), Hanzeplein 1, 9700 RB, Groningen, The Netherlands.
¹⁰ Department of Traumatology, Oslo University Hospital Ullevål, Kirkeveien 166, 0450, Oslo, Norway.
¹¹ Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Raemistr. 100, 8091, Zurich, Switzerland.

PMID: 36227354
DOI: 10.1007/s00068-022-02126-3

Abstract

Introduction: Fixation of major fractures plays a pivotal role in the surgical treatment of polytrauma patients. In addition to ongoing discussions regarding the optimal timing in level I trauma centers, it appears that the respective trauma systems impact the implementation of both, damage control and safe definitive surgery strategies. This study aimed to assess current standards of polytrauma treatment in a Europe-wide survey.

Methods: A survey, developed by members of the polytrauma section of ESTES, was sent online via SurveyMonkey^®, between July and November 2020, to 450 members of ESTES (European Society of Trauma and Emergency Surgery). Participation was voluntary and anonymity was granted. The questionnaire consisted of demographic data and included questions about the definition of "polytrauma" and the local standards for the timing of fracture fixation.

Results: In total, questionnaires of 87 participants (19.3% response rate) were included. The majority of participants were senior consultants (50.57%). The mean work experience was 19 years, and on average, 17 multiple-injured patients were treated monthly. Most of the participants stated that a polytrauma patient is defined by ISS ≥ 16 (44.16%), followed by the "Berlin Definition" (25.97%). Systolic blood pressure < 90 mmHg, tachycardia or vasopressor administration (86.84%), pH deviation, base excess shift (48.68%), and lactate > 4 mmol (40.79%) or coagulopathy defined by ROTEM (40.79%) were the three most often stated indicators for shock. Local guidelines (33.77%) and the S-3 Guideline by the DGU® (23.38%) were mostly stated as a reference for the treatment of polytrauma patients. Normal coagulation (79.69%), missing administration of vasopressors (62.50%), and missing clinical signs of "SIRS" (67.19%) were stated as criteria for safe definite secondary surgery.

Conclusion: Different definitions of polytrauma are used in the clinical setting. Indication for and the extent of secondary (definitive) surgery are mainly dependent on the polytrauma patient`s physiology. The «Window of Opportunity» plays a less important role in decision making.

Keywords: Damage control orthopaedics; Fracture care; Major fractures; Polytrauma.