A trinity strategy for the treatment of multiple orthopedic trauma and assessment of its clinical application
Objective To explore the clinical value of a trinity strategy for the treatment of multiple orthopedic trauma.Methods A retrospective case series study was conducted to analyze the clinical data of 1 267 patients with multiple orthopedic trauma admitted to Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and the First Affiliated Hospital of Navy Medical University from June 2013 to May 2023,including 862 males and 405 females,aged 18-93 years[(55.2±19.8)years].Associated injuries included hemorrhagic shock in 632 patients,traumatic wet lung in 274,cranial injuries in 135,abdominal and pelvic bleeding in 116,pneumothorax in 89,urinary injury in 13,and vesical rupture in 8.All the patients were treated with the trinity strategy and the treatment process was divided into the phases of first aid,remodeling,and rehabilitation.The first aid phase focused on stabilizing symptoms and saving lives;the remodeling phase centered on restoring the anatomical structure and alignment;the rehabilitation phase aimed for functional recovery through the integration of both Western and traditional Chinese medicine.The all-cause mortality within 30 days after surgery and fracture healing time were calculated;the excellent and good rates of Constant-Murley shoulder score,Mayo elbow score,Gartland-Werley wrist score,Harris hip score,Hospital for Special Surgery(HSS)knee score and the American Orthopedic Foot&Ankle Society(AOFAS)ankle-hindfoot score at the last follow-up and the overall excellent and good rate of all joint function scores were measured.The short form health survey(SF-36)scores were collected preoperatively and at 6 months postoperatively,including 8 aspects such as physical functioning,physical role,bodily pain,general health,vitality,social functioning,emotional role,and mental health.The incidence of postoperative complications was recorded.Results All the patients were followed up for 6-18 months[(10.2±4.2)months].The mortality rate during the acute phase(within 30 days after surgery)was 2.37％with 12 deaths due to hemorrhagic shock,10 due to traumatic brain injury,6 due to multiple organ dysfunction syndrome(MODS),and 2 due to pulmonary infection.The average fracture healing time averaged 3.8-18 months[(11.5±4.2)months],with 89.49％of the patients having bone union within 12 months after surgery,8.93％having bone union within 18 months after surgery,and 1.58％undergoing reoperation.For the patients with internal fixation failure and nonunion,the average healing time was extended to(10.2±2.2)months and(13.7±3.3)months respectively.At the last follow-up,the excellent and good rates of Constant-Murley shoulder score,Mayo elbow score,Gartland-Werley wrist score,Harris hip score,HSS knee score,and AOFAS ankle-hindfoot score were 83.93％,90.24％,94.12％,85.57％,88.46％,and 92.31％respectively,with an overall excellent and good rate of 89.11％.At 6 months after surgery,the SF-36 scores of all the patients in the eight dimensions,including the physical functioning,physical role,bodily pain,general health,vitality,social functioning,emotional role,and mental health were(74.4±8.6)points,(44.7±14.4)points,(77.4±10.9)points,(68.4±18.2)points,(72.5±16.0)points,(76.8±8.7)points,(49.9±17.6)points,and(72.8±17.9)points,significantly improved compared with those before operation[(63.4±12.7)points,(30.9±17.4)points,(56.4±18.0)points,(55.4±24.7)points,(53.5±21.0)points,(55.8±24.3)points,(36.9±24.0)points,(58.8±21.6)points](P＜0.01).Complications of different degrees occurred in 214 patients(16.89％),including lung infections in 118 patients(9.31％),lower extremity deep vein thrombosis in 50(3.95％),pressure injuries in 26(2.05％),internal fixation failure in 12(0.95％),and nonunion in 8(0.63％).Conclusions The trinity strategy provides whole-process management,personalized treatment,and overall rehabilitation for multiple orthopedic trauma.It can decrease mortality,shorten fracture healing time,improve joint function and quality of life,and reduce the incidence of complications.
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