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Open Versus Closed Extremity Fractures In The Trauma ICU: Current Trends In Morbidity And Mortality

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Author(s): Michael J. Kilbourne*,Grant V. Bochicchio**,Kimberly M. Lumpkins***,Kelly Bochicchio**,Thomas Scalea, MD**

Journal: Journal of Orthopaedics
ISSN 0972-978X

Volume: 5;
Issue: 3;
Date: 2008;
Original page

Keywords: Extremity fracture | open | closed | trauma | ICU | morbidity | mortality

ABSTRACT
Abstract:Background: Open fractures are more complicated to manage than closed fractures due to their associated soft tissue disruption, requiring more frequent operative intervention and wound care, with significantly greater risk of infection. In this study, we sought to evaluate the impact of open fractures on morbidity and mortality in today’s critically injured trauma patient.Methods: Prospective data were analyzed on 517 blunt trauma patients admitted to the ICU with extremity fractures. Patients were divided into two groups: open fractures (diagnosis of at least one open long bone fracture) or closed fractures (diagnosis of only closed fractures). Both univariate analysis and multivariate logistic regression analysis were performed for each group controlling for age, gender and Injury Severity Score (ISS) to evaluate outcomes.Results: Univariate analysis revealed no significant difference between the open fracture vs. closed fracture groups for hospital length of stay (HLOS); 22±14 days vs. 21±17 days, p= 0.20, ICU length of stay (ILOS); 14±12 days vs. 14±11 days, p= 0.43, ventilator days; 13±12 days vs. 12±12 days, p= 0.51, or mortality; 12% vs. 13%, p= 0.85. Multivariate linear regression analysis demonstrated that fracture type (open vs. closed) was not predictive of HLOS (coefficient 1.46, p= 0.33), ILOS (coefficient 0.65, p= 0.52), ventilator days (coefficient 0.65, p= 0.57), or mortality (odds ratio 1.14, 95% CI 0.64-2.01).Conclusion: Despite the more complex nature of open versus closed long bone fractures, open fractures do not appear to increase the risk of morbidity or mortality in today’s critically injured blunt trauma patient
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