title: The impact of major operative fractures in blunt abdominal injury.
abstract: BACKGROUND
  Abdominal injury has been shown to be an independent risk factor for pulmonary complications in patients with extremity injuries. We propose to characterize orthopedic patients with severe abdominal trauma. We hypothesize that operative fractures of the thoracolumbar spine, pelvis, acetabulum, or femur increase systemic complications in patients with blunt abdominal injury.
  
  
  METHODS
  A retrospective review of patients presenting to a Level I trauma center with abdominal injury between 2000 and 2006 was performed. Adult patients between the ages of 18 years and 65 years with high-energy, blunt trauma resulting in severe abdominal injury (abdomen Abbreviated Injury Scale [AIS] score ≥ 3) and Injury Severity Score (ISS) of 18 or greater were included. Patients were divided into two comparison groups as follows: the fracture group had operative fractures of the pelvis, acetabulum, thoracolumbar spine, and/or femur, and the control group did not sustain these fractures of interest. Systemic complications were documented. Unadjusted and multivariable logistic regression analyses were performed.
  
  
  RESULTS
  The control group included 91 patients, and the fracture group included 106 patients with 136 fractures of interest. With unadjusted analysis, the fracture group had more complications (34% [36 of 106] vs. 18% [16 of 91], p = 0.010), including adult respiratory distress syndrome (8% [8 of 106] vs. 1% [1 of 91], p = 0.040), and sepsis (11% [12 of 106] vs. 3% [3 of 91], p = 0.056). Logistic regression modeling demonstrates that the presence of an operative fracture increased the odds of developing at least one complication approximately three times (odds ratio, 2.88, p = 0.006), after controlling for presence of chest injury and type of injured abdominal organ.
  
  
  CONCLUSIONS
  Operative fractures of the thoracolumbar spine, pelvis, acetabulum and femur increase the risk of developing systemic complications in patients with blunt abdominal injury. Further study is necessary to optimize treatment protocols for these high-risk patients.
authors.affiliation: Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio 44109, USA.
authors.forename: Nickolas J
authors.initials: NJ
authors.lastname: Nahm
authors.forename: John J
authors.initials: JJ
authors.lastname: Como
authors.forename: Heather A
authors.initials: HA
authors.lastname: Vallier
mesh_terms: D000007:Abdominal Injuries / Q000150:complications*; D000077:Acetabulum / Q000293:injuries; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005264:Femoral Fractures / Q000150:complications; D050723:Fractures, Bone / Q000150:complications*; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications*; D010384:Pelvic Bones / Q000293:injuries; D012128:Respiratory Distress Syndrome / Q000209:etiology; D012189:Retrospective Studies; D018805:Sepsis / Q000209:etiology; D016103:Spinal Fractures / Q000150:complications; D013904:Thoracic Vertebrae / Q000293:injuries; D014193:Trauma Centers / Q000706:statistics & numerical data; D014949:Wounds, Nonpenetrating / Q000150:complications*; D055815:Young Adult