Options to Determine the Time for Conversion Osteosynthesis in Patients With Multiple Trauma

Abstract

Objective: To reduce the complication rate in patients with multiple trauma (including bone fractures) by objectifying criteria that allow conversion from the external fixator to the definitive osteosynthesis.Materials and methods: The study was based on a retrospective analysis of the treatment outcomes in 308 patients (18­60 years, males and females) with multiple trauma and no apparent comorbidity.All patients were divided into 3 groups depending on the treatment outcomes. The therapeutic and diagnostic approaches in both groups were equal and compliant with the current standards and guidelines. Surgical treatment was performed according to the damage control principles in orthopedics.As the groups were statistically comparable, their data could be used for an accurate comparative statistical analysis.Results: The statistical analysis of the treatment outcomes in patients from all the groups demonstrated the possibility of using the SOFA scale to determine the conversion time. In patients who underwent conversion osteosynthesis, with comparable severity of injuries according to the NISS scale, a SOFA score >10 points right prior to the surgery was associated with the maximum number of complications including mortality. A SOFA score <6 points right prior to the surgery was associated with significantly lower number of complications and no mortality.Conclusions: Objective tools for assessing the severity of the condition, such as the SOFA scale, will allow to customize the approach to the time of conversion osteosynthesis in patients with multiple trauma and improve the treatment outcomes in general.