Orthopaedic Surgical Prioritization in the Polytrauma Patient - A Retrospective Analysis

Résumé

Background: The study aims to evaluate orthopaedic surgical prioritisation patterns and clinical outcomes in polytrauma patients managed at tertiary care centers. Methods & Materials: This retrospective observational study was conducted at Gazi Medical College and Hospital (GMCH) and Khulna Medical College and Hospital (KMCH), Bangladesh, from January 2022 to December 2023, involving 50 polytrauma patients aged ≥18 years with at least one orthopedic fracture requiring surgical or conservative management. Data were extracted from electronic medical records using a structured sheet. Variables included demographics, injury mechanism, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), surgical details, ICU stay, timing of surgery, rationale for prioritization, and in-hospital outcomes. Early surgery was defined as intervention within 24 hours. Data were analyzed using SPSS version 26.0 with descriptive statistical methods. Result: Among the 50 polytrauma patients analyzed, the majority were males (76.0%) aged 21–40 years (50.0%), with a mean age of 33.6±12.4 years. ICU admission was needed in 36.0% of cases, with a mean ICU stay of 4.2±2.3 days. Road traffic accidents were the predominant cause of injury (70.0%), and 34.0% had severe injuries (ISS 16–24). Most patients (68.0%) had mild GCS scores (13–15). Femur and tibia/fibula fractures were most common (24.0% each), and 70.0% of fractures were closed. Delayed surgery (≥24 hrs) occurred in 60.0% of cases, with ORIF as the most frequent procedure (40.0%). Favorable outcomes included 84.0% ambulatory at discharge and 4.0% mortality. Conclusion: This study concludes that tailored orthopedic surgical prioritization based on patient stability, injury severity, and fracture complexity can improve outcomes in polytrauma cases, achieving high ambulation rates with minimal complications. Multidisciplinary strategies in tertiary care settings are vital to managing lower limb injuries and optimizing patient recovery effectively.