FACTORS PREDICTIVE OF IMMOBILIZATION COMPLICATIONS IN PEDIATRIC POLYTRAUMA

Participants: R.T. Loder, L.J. Gullahorn, E.H. Yian, M.R. Ferrick, D.S. Raskas, M.L.V.H. Greenfield

Keywords: polytrauma, children, fracture, complications, osteosynthesis, immobilization

Introduction

Trauma is the single leading cause of childhood mortality (1, 2) and is second only too acute infection as the leading cause of morbidity. It has been well documented in the adult polytrauma patient that early, aggressive fracture fixation and supportive care reduce morbidity and mortality (3, 4, 5). Although the role of surgical treatment of pediatric fracture is increasing, the role of early fracture stabilization in pediatric polytrauma has not been well defined (5, 6, 7, 8). The duration of bedrest and immobilization due to a fracture is one of the few variables in the polytrauma patient that is potentially under the control of the orthopaedic surgeon; if a child develops a complication of immobilization, could this be prevented by aggressive osteosynthesis and mobilization of the patient? The purpose of this study was to investigate this question and to specifically determine which variables might be predictive of the development of a complication of immobilization.

Materials and Methods

We retrospectively studied 93 polytrauma children with at least one major musculoskeletal injury to determine which variable(s) would predict the development of complications related to immobilization.

Results

Motor vehicle incidents accounted for 80% of the injuries. The average age was 8.0 + 4.1 years. There were 152 fractures in the 93 children. There were 35 complications in 22 children and 4 children died. The average Modified Injury Severity Scale (MISS) was 24.5 + 13.6. A stepwise forward logistic regression revealed two variables predictive of complications related to immobilization: age and MIS score. Complications related to immobilization were positively associated with being older than 7 years of age (p = 0.027; OR = 9.5, 95% CI 1.4, 64.9) and having a MISS score greater than 40 (p = 0.005; OR = 14.1, 95% CI 2.2, 89.1)

Conclusion

In an effort to reduce complications of immobilization, we recommend consideration of early fracture stabilization in those patients who are older than 7 years of age and with a Modified Injury Severity Score of greater than 40, and who have orthopaedic injuries that require bed rest to obtain or maintain acceptable alignment

References

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