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Clinical implications of fracture-associated vascular damage in extremity and pelvic trauma

BACKGROUND: Vascular damage in polytrauma patients is associated with high mortality and morbidity. Therefore, specific clinical implications of vascular damage with fractures in major trauma patients are reassessed. METHODS: This comprehensive nine-year retrospective single center cohort study anal...

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Autores principales: Gilbert, F., Schneemann, C., Scholz, C. J., Kickuth, R., Meffert, R. H., Wildenauer, R., Lorenz, U., Kellersmann, R., Busch, A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6247697/
https://www.ncbi.nlm.nih.gov/pubmed/30458745
http://dx.doi.org/10.1186/s12891-018-2333-y
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author Gilbert, F.
Schneemann, C.
Scholz, C. J.
Kickuth, R.
Meffert, R. H.
Wildenauer, R.
Lorenz, U.
Kellersmann, R.
Busch, A.
author_facet Gilbert, F.
Schneemann, C.
Scholz, C. J.
Kickuth, R.
Meffert, R. H.
Wildenauer, R.
Lorenz, U.
Kellersmann, R.
Busch, A.
author_sort Gilbert, F.
collection PubMed
description BACKGROUND: Vascular damage in polytrauma patients is associated with high mortality and morbidity. Therefore, specific clinical implications of vascular damage with fractures in major trauma patients are reassessed. METHODS: This comprehensive nine-year retrospective single center cohort study analyzed demography, laboratory, treatment and outcome data from 3689 patients, 64 patients with fracture-associated vascular injuries were identified and were compared to a control group. Results: Vascular damage occurred in 7% of patients with upper and lower limb and pelvic fractures admitted to the trauma room. Overall survival was 80% in pelvic fracture and 97% in extremity fracture patients and comparable to non-vascular trauma patients. Additional arterial damage required substantial fluid administration and was visible as significantly anemia and disturbed coagulation tests upon admission. Open procedures were done in over 80% of peripheral extremity vascular damage. Endovascular procedures were predominant (87%) in pelvic injury. CONCLUSION: Vascular damage is associated with high mortality rates especially in combination with pelvic fractures. Initial anemia, disturbed coagulation tests and the need for extensive pre-clinical fluid substitution were observed in the cohort with vascular damage. Therefore, fast diagnosis and early interventional and surgical procedures are necessary to optimize patient-specific outcome. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12891-018-2333-y) contains supplementary material, which is available to authorized users.
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spelling pubmed-62476972018-11-26 Clinical implications of fracture-associated vascular damage in extremity and pelvic trauma Gilbert, F. Schneemann, C. Scholz, C. J. Kickuth, R. Meffert, R. H. Wildenauer, R. Lorenz, U. Kellersmann, R. Busch, A. BMC Musculoskelet Disord Research Article BACKGROUND: Vascular damage in polytrauma patients is associated with high mortality and morbidity. Therefore, specific clinical implications of vascular damage with fractures in major trauma patients are reassessed. METHODS: This comprehensive nine-year retrospective single center cohort study analyzed demography, laboratory, treatment and outcome data from 3689 patients, 64 patients with fracture-associated vascular injuries were identified and were compared to a control group. Results: Vascular damage occurred in 7% of patients with upper and lower limb and pelvic fractures admitted to the trauma room. Overall survival was 80% in pelvic fracture and 97% in extremity fracture patients and comparable to non-vascular trauma patients. Additional arterial damage required substantial fluid administration and was visible as significantly anemia and disturbed coagulation tests upon admission. Open procedures were done in over 80% of peripheral extremity vascular damage. Endovascular procedures were predominant (87%) in pelvic injury. CONCLUSION: Vascular damage is associated with high mortality rates especially in combination with pelvic fractures. Initial anemia, disturbed coagulation tests and the need for extensive pre-clinical fluid substitution were observed in the cohort with vascular damage. Therefore, fast diagnosis and early interventional and surgical procedures are necessary to optimize patient-specific outcome. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12891-018-2333-y) contains supplementary material, which is available to authorized users. BioMed Central 2018-11-20 /pmc/articles/PMC6247697/ /pubmed/30458745 http://dx.doi.org/10.1186/s12891-018-2333-y Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Gilbert, F.
Schneemann, C.
Scholz, C. J.
Kickuth, R.
Meffert, R. H.
Wildenauer, R.
Lorenz, U.
Kellersmann, R.
Busch, A.
Clinical implications of fracture-associated vascular damage in extremity and pelvic trauma
title Clinical implications of fracture-associated vascular damage in extremity and pelvic trauma
title_full Clinical implications of fracture-associated vascular damage in extremity and pelvic trauma
title_fullStr Clinical implications of fracture-associated vascular damage in extremity and pelvic trauma
title_full_unstemmed Clinical implications of fracture-associated vascular damage in extremity and pelvic trauma
title_short Clinical implications of fracture-associated vascular damage in extremity and pelvic trauma
title_sort clinical implications of fracture-associated vascular damage in extremity and pelvic trauma
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6247697/
https://www.ncbi.nlm.nih.gov/pubmed/30458745
http://dx.doi.org/10.1186/s12891-018-2333-y
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