J Trauma, 2008
Kerwin et al.25
|
Try to achieve physiological stability to stabilize the fracture in the first 72 hours. Use clinical judgment
to determine the time of stabilization. |
4 |
C |
J Crit Care, 2014
Park et al.26
|
Patients with ISS>26 have better clinical course after early stabilization (<72 h), surgery should be considered based on the patient’s medical condition and the anesthetic and surgical risks. |
2b |
B |
J Can, 2011
Pakzad et al.39 |
Patients stabilized after 24 hours are nearly 8 times more likely to suffer complications related to prolonged bed rest. Those stabilized within the first 24 hours are more likely to recover. An effort should be made to avoid delaying early treatment. |
4 |
C |
J Orthop Trauma, 2013
Vallier et al.36
|
The times spent in hospital and in the ICU are clearly influenced by the time the surgery is performed, which in turn, should be determined taking both the physiological state of the patient and the complexity of the surgery into account. |
2b |
B |
Ann Surf, 2001
Croce et al.27
|
The fixation of the fracture within the first 72 hours is beneficial in traumatized patients; it reduces the incidence of pneumonia in patients with fractures of the thoracic spine, with severe associated thoracic lesions, and in patients without neurological deficit. |
4 |
C |
J Trauma Acute Care Surf, 2014
Bliemel et al.28
|
The stabilization of the fracture before 72 h have elapsed is apparently beneficial and every effort should be made for an early treatment, associated with a reduced hospitalization time
and a low frequency of complications. |
4 |
C |
Spine J, 2013
Konieczny et al.29
|
Patients with severe thoracic trauma and initially low hemoglobin counts may be at risk for a poor clinical outcome from early fixation. Therefore, the patients who are candidates for early surgery
must be carefully selected. |
2b |
B |
Eur J Trauma Emerg Surg, 2007
Hierholzer et al.35
|
Surgery within the first 24 h is associated with a reduction in mortality, in the duration of ventilation,
and in the stay in the ICU. |
4 |
C |
J Bone Joint Surg, 2006
McHenry et al34
|
A surgical delay of more than two days results in an increased risk of respiratory failure, but the time
of the surgery must be determined on an individual basis. |
3b |
B |
J Trauma, 2010
Frangen et al.30
|
Early stabilization (<72 h) is safe. In seriously injured patients it does not alter the perioperative pulmonary function and it results in a shorter stay in the ICU and a shorter hospitalization. |
4 |
C |
J Trauma, 2005
Kerwin et al.31
|
Early stabilization (<72 h) reduces the hospital stay. Patients with traumas of the thoracic spine and spinal cord lesions have a greater benefit in terms of morbidity, hospital stay, and stay in the ICU. Mortality is higher in patients with ISS > 25. A rigid protocol indicating early stabilization of the spine does not seem to be justified. Early stabilization should always be performed if possible, but it should be individualized,
optimizing any physiological changes preoperatively. |
4 |
C |
J Trauma Acute Care Surg, 2013
Stahel et al.8
|
Recommends posterior fixation before 24 h, in case of compromise of the anterior spine or instability, anterior 360º fusion 3 days after the trauma to avoid the acute phase of hyperinflammation and to ensure resuscitation. It reduces days on the ventilator, hospitalization time, and early postoperative complications. |
2b |
B |
J Orthop Trauma, 2013
Vallier et al.37
|
Recommends definitive management of mechanically unstable fractures of the pelvis, acetabulum, proximal femur, femoral shaft, and spine within the first 36 h whenever the patient displays an adequate response to resuscitation based on the improvement of acidosis. |
4 |
C |
J Orthop Trauma, 1996
Schlegel et al.32
|
Surgical intervention before 72 h reduces the rate of complications, days in the hospital and in the ICU in patients with multiple traumatic injuries and surgical fractures of the spine. In patients with isolated fractures of the spine, the time of fixation does not change the outcome. |
4 |
C |
J Trauma, 2006
Schinkel et al.33
|
Stabilization of the thoracic spine before 3 days seems to be favorable; there is an improvement in the TRISS, less hospitalization and ICU time, shorter duration of ventilation, and lower incidence of pulmonary failure. Patients with ISS>38 benefit more. |
4 |
C |
Arch Orthop Trauma Surg, 2008
Cengiz et al.15
|
Stabilization within the first 8 h seems to be favorable. It can improve neurological recovery, reduce hospitalization time and systemic complications in patients with spinal cord lesions. |
1b |
A |
Spine, 1999
McLain et al.38
|
Stabilization before 8 hours is safe and appropriate in polytraumatized patients when the neurological deficit is progressive, the trauma is throacoabdominal, or the instability of the fracture increases the risk of deferred treatment. Surgical intervention before 24 h is not more dangerous than that performed between 24 and 72 hours. |
2b |
B |
J Trauma, 2007
Kerwin et al.9
|
Fixation prior to 48 h seems to increase mortality. Incomplete resuscitation prior to surgery seems to contribute. Surgical fixation before 48 h is not justified. Clinical judgment should be used and the physiological state of the patient should be considered to determine the best time to perform the fixation. |
4 |
C |
