Incidence and significance of injuries to the foot and ankle in polytrauma patients--an analysis of the Trauma Registry of DGU.
BACKGROUND
Injuries to the foot and ankle are often missed or underestimated during the initial care for polytraumatized patients. Nonetheless, injuries to the lower extremity exert significant influence on long-term outcome after discharge from the acute care facility. Since the mortality of trauma decreased in the last decades, these injuries gain more effect on the overall outcome. We analysed foot and ankle injury patterns, associated procedures and special characteristics of this population during early care.


METHODS
Multiply injured patients of the Trauma Registry of DGU (TR-DGU; Injury Severity Score, ISS > or = 16) with injuries to the foot and ankle (group F&A) were compared to the remaining TR-DGU population (group Non-F&A) for differences in injury characteristics, surgical treatment and early outcome. A detailed comparative statistic is provided.


RESULTS
Demographic data and injury severity were comparable between the groups. The group F&A showed significantly more falls from a height above 3m and suicidal injuries. Their overall injury severity to the extremities, especially to the regions different from the foot and ankle, was significantly higher compared to group Non-F&A. Group F&A patients had more surgeries and less intensive care complications. Mortality was 11.6% (F&A) and 16.2% (Non-F&A). Concerning initial outcome when discharged from the acute care facility, group F&A patients more commonly were moderately or severely disabled in everyday life.


CONCLUSIONS
Our data enhance the need for a meticulous search for injuries to the foot and ankle in patients with falls, comparably light injuries to the trunk and head and especially in patients with multiple and severe injuries to the skeletal system. Since 88.4% of patients with foot and ankle injuries are discharged alive, early appropriate care should be given to these injuries that significantly affect long-term outcome.
Probst
Christian
C
Hannover Medical School, Dept. of Trauma, Carl-Neuberg-Str. 1, 30625 Hannover, Germany. probst.christian@mh-hannover.de
Richter
Martinus
M
Lefering
Rolf
R
Frink
Michael
M
Gaulke
Ralph
R
Krettek
Christian
C
Hildebrand
Frank
F
D015998:Abbreviated Injury Scale; D000058:Accidental Falls / Q000706:statistics & numerical data; D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D000368:Aged; D016512:Ankle Injuries / Q000453:epidemiology*; D005260:Female; D018409:Foot Injuries / Q000453:epidemiology*; D005858:Germany / Q000453:epidemiology; D023261:Glasgow Outcome Scale; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications / Q000453:epidemiology*; D017063:Outcome Assessment, Health Care; D012042:Registries / Q000706:statistics & numerical data*; D013406:Suicide, Attempted / Q000706:statistics & numerical data; D055815:Young Adult