title: Early versus late surgery of thoracic spine fractures in multiple injured patients: is early stabilization always recommendable?
abstract: BACKGROUND
  Many institutions' retrospective studies investigated the effect of the timing of surgery on outcomes of polytraumatized patients with severe lesions of the thoracic spine and mainly found a better outcome for patients who were operated on less than 72 hours posttrauma.
  
  
  OBJECTIVE
  We conducted a prospective study in a Level I trauma center to validate the retrospective data and to investigate other variables, in addition to the timing of surgery that may influence patient outcomes.
  
  
  METHODS
  Prospective observational clinical study.
  
  
  METHODS
  Within this prospective study at a Level I trauma center, we enrolled 38 multiple injured patients with unstable fractures of vertebral column from Level Th1 to L1. Further inclusion criteria consisted of an injury severity score of 16 or more and an intensive care unit (ICU) stay of more than 7 days. The age of included patients was limited from 16 or more to 75 or less years.
  
  
  METHODS
  Hospital stay, stay on ICU, and mortality.
  
  
  METHODS
  Twenty-two patients were operated on less than or equal to 72 hours posttrauma, and 16 received late surgery greater than or equal to 72 hours posttrauma.
  
  
  RESULTS
  Patients who received early surgery had a significantly higher mortality rate (p<.01) than those who received late surgery. Sixty-seven percent of our patients who had an initial hemoglobin (Hb) less than 10 mg/dL died. Seventy-five percent of those patients who had an Hb less than 10 mg/dL and received a thoracic drain died.
  
  
  CONCLUSIONS
  Although some reports indicate advantages for early surgery for thoracic spine trauma in the polytraumatized patient, careful patient selection should be used. Based on the results of this prospective study, early surgery for thoracic spine trauma in patients with concomitant severe thoracic trauma and low initial Hb levels may pose a risk for poor clinical outcomes.
authors.affiliation: Department of Traumatology, University Hospital Bergmannsheil, Bürkle de la Camp-Platz 1, 44789 Bochum, Germany; Department of Orthopedic Surgery, University Hospital Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany. Electronic address: Markus@Konieczny.net.
authors.forename: Markus R
authors.initials: MR
authors.lastname: Konieczny
authors.affiliation: Department of Orthopedics and Rheumatology, University Hospital Marburg, Baldingerstraße, 35043 Marburg, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Strüwer
authors.affiliation: Department of Traumatology, University Hospital Bergmannsheil, Bürkle de la Camp-Platz 1, 44789 Bochum, Germany.
authors.forename: Birger
authors.initials: B
authors.lastname: Jettkant
authors.affiliation: Department of Traumatology, University Hospital Bergmannsheil, Bürkle de la Camp-Platz 1, 44789 Bochum, Germany; Department of Traumatology, Klinikum Memmingen, Bismarckstraße 23, 87700 Memmingen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Schinkel
authors.affiliation: Department of Traumatology, University Hospital Bergmannsheil, Bürkle de la Camp-Platz 1, 44789 Bochum, Germany; Department of Traumatology, St Josefs Hospital Bonn-Beul, Hermannstraße 37, 53225 Bonn, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kälicke
authors.affiliation: Department of Traumatology, University Hospital Bergmannsheil, Bürkle de la Camp-Platz 1, 44789 Bochum, Germany.
authors.forename: Gert
authors.initials: G
authors.lastname: Muhr
authors.affiliation: Department of Traumatology, University Hospital Bergmannsheil, Bürkle de la Camp-Platz 1, 44789 Bochum, Germany; Department of Orthopedics and Traumatology, Elisabeth-Klinik Bigge, Heinrich-Sommer-Straße 4, 59939 Olsberg, Germany.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Frangen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000293:injuries* / Q000601:surgery*; D013997:Time Factors; D014193:Trauma Centers; D055815:Young Adult
keywords: Polytrauma; Second hit; Thoracic spine fracture; Thoracic trauma; Timing of surgery