The optimal timing for definitive operative stabilization of pelvic fractures in polytrauma patients: effects on clinical outcomes - a systematic review.

Abstract

Purpose: The optimal timing for definitive surgical treatment of pelvic fractures in polytrauma patients remains a topic of ongoing discussion due to the complexity of these injuries. This analysis therefore aims to systematically compare early versus late definitive operative stabilization of pelvic fractures on outcome in polytrauma patients.

Methods: PubMed, CENTRAL and Web of Science were systematically searched to identify relevant completed and ongoing studies from the inception of each database to March 13, 2023. Systematic reviews, randomized control trials (RCTs) and observational studies comparing early (< 24 h) versus late (> 24 h) definitive operative stabilization in adult polytrauma patients admitted to the ICU were included.

Results: Since no systematic reviews and RCTs were available on this subject, one observational study was identified, including a total of 418 polytrauma patients (n_early = 165, n_late = 253), median age: 40.3 years (early 40.1 years, late 40.4 years). Early definitive stabilization was associated with a decreased risk of acute respiratory distress syndrome (ARDS) compared to late stabilization of unstable pelvis and acetabulum fractures (RR 0.38, 95% CI 0.18-0.81; RD 78 fewer per 1000, 95% CI 104 fewer to 24 fewer; 1 study, 418 participants; very low certainty of evidence). Furthermore, early definitive stabilization may decrease the risk of pneumonia compared to late stabilization of unstable pelvis and acetabulum fractures (RR 0.50, 95% CI 0.28-0.88; RD 85 fewer per 1000, 95% CI 122 fewer to 20 fewer); 1 study, 418 participants; very low certainty of evidence).

Conclusion: There is limited evidence regarding early definitive fracture repair (≤ 24 h) compared to late repair of pelvic fractures in polytrauma patients. One observational study showed a reduced incidence of septic respiratory complications, ARDS, and multi-organ failure (MOF) in polytrauma patients who received early definitive fracture repair.