Langzeitnachuntersuchung polytraumatisierter Patienten mit Frakturen des Acetabulums oder der unteren Extremität : welche Verletzungen verursachen dauerhaft größere Probleme?
BACKGROUND: Over the last decades, improved preclinical and clinical trauma care has markedly decreased the mortality rates of polytrauma patients. With increased survival rates, the functional outcome and the quality of life following injury have gained importance in the evaluation of polytrauma patients. However, the long- term clinical status of patients following polytrauma has not been well described.OBJECTIVE: This study focusses on polytraumatized patients with fractures of the acetabulum or the lower extremities. Its goal is to evaluate the effect of the different fracture localizations on long-term functional outcome. METHODS: In the “Hannover-Polytrauma-Longterm-Study“, the social and medical sequelae of severe trauma were reinvestigated at least 10 years after the injury using a standardized physical examination by a doctor as well as a patient questionnaire. 637 patients were evaluated in total. Inclusion criteria for this analysis were: polytrauma, solitary fractures of the acetabulum, proximal femur, femoral shaft, knee joint oder tibial shaft as well as patient age between 3 and 60 years at the time of trauma. Exclusion criteria were considered to be amputations, joint replacement, and incomplete follow-up data. Parameters of follow-up examination included persistance of pain, range of motion, limping, success of rehabilitation, the ability to work and outcome scores (HASPOC, SF-12).RESULTS: 229 Patients matched the inclusion criteria and had solitary fractures of one of the examined bodyregions. The results demonstrate a correlation between the functional long- term results and the localization of the lower- extremity fractures. The main results can be summarized as follows: (1) Patients following fractures of the acetabulum or the knee joint have significantly worse long- term results concerning general health, success of rehabilitation and ability to work than the other patients with lower- extremity fractures. Especially patients suffering from acetabular fractures seem to be particularly problematic concerning long- term rehabilitation. (2) Patients who sustained femoral shaft fractures have the significantly best long- term results concerning the investigated parameters. (3) There is no statistically significant difference between the different fracture-sites concerning the persistance of local pain.CONCLUSIONS: Fracture localization is a determining factor for long- term rehabilitation results following polytrauma. Multiple factors play an important role in construing the shown results. Presumably, the complexity of surgical treatment, adjacence to joint regions, the anatomical relation to neurovascular structures and the affection of cartilage tissue with decreased blood supply immensely influence the late outcome. Also, thin soft- tissue envelope, an increased probability of soft- tissue destruction and peripheral hypoperfusion distal to the knee- joint seem to be predictors of unfavourable outcome. Furthermore, heterotopic ossifications, posttraumatic arthritis, instability, muscular insufficiency and osteoporosis alter the rehabilitation results and contribute to the results described above. Modern concepts of therapy as well as the establishment of trauma center care have had a great impact on the improvement of functional outcome of severely injured patients. Still, the continuous adjustment of therapeutical strategies is crucial. This study contributes to validate and improve the recent guidelines of polytrauma care and to constantly augment the long- term results of polytrauma care. Certain individual rehabilitation needs can be focussed better and therapeutic difficulties can be anticipated earlier in order to provide a more individual and effective rehabilitation. Therefore, particularly patients with articular fractures should be targeted to improve functional and rehabilitation results.
info:eu-repo/classification/ddc/610, Polytrauma, Nachuntersuchung, Rehabilitation, Hüftgelenkpfanne, Bein, Medizin, follow-up, acetabulum, lower limb
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