Pape et al identified patients who may have an adverse outcome after early fracture fixation. These patients may benefit from damage control orthopedic surgery. The authors are from Hannover Medical School in Germany.


Parameters associated with an adverse outcome to early fracture surgery:

(1) "borderline" patient (see under damage control orthopedic surgery, above)

(2) platelet count < 90,000 per µL

(3) hypothermia with body temperature < 32°C

(4) shock AND transfusion of > 25 units of blood

(5) multiple long bone fractures AND truncal AIS >= 2

(6) time required in the operating room > 6 hours

(7) arterial injury AND systolic blood pressure < 90 mm Hg

(8) exaggerated inflammatory response with elevated cytokines (IL-6 > 800 pg/mL)



• The listing also includes bilateral lung contusions on chest X-ray, but this is also included as a "borderline" finding.


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