To identify risk factors To know the influence of multiple skeletal injuries leading to non orthopaedic complications

1. Presenter : Dr.B.Naveen Thiyagu
Co-Authors : Dr.R.Nitesh
Dr.V.S.Kumar
Dr.Manjunath Bargava
Prof. S. Ramesh Babu
Sri Ramachandra Medical College & Research Institute
(Deemed University)
Chennai – 600 116. Tamil Nadu, INDIA.

2. AIM
To identify risk factors
To know the influence of multiple
skeletal injuries leading to non
orthopaedic complications

3. MATERIAL
 Retrospective study
 Period of study : March 2001 to
March 2003
 Total no. of cases: 96
 M : F : 6 : 1
 Age : 20 to 60 yrs
Av : 37.8 yrs

4. INCLUSION CRITERIA
2 or more fractures involving specific
body regions - Arm, Forearm, Thigh,
Leg, Pelvis, Spine
EXCLUSION CRITERIA
 Any other organ injury
 Age < 18 yrs
 Pathological fractures

5. CRITERIA FOR DIAGNOSIS*
 ARDS - Tachypnoea,
Air Hunger,Hypoxemia.
 PE - Clinical & ECG
 PNEUMONIA - Fever,Leucocytosis, X-
ray infilterates
 DIC - Increase PT,APTT,
D Dimer, decrease
fibrinogen
Potential haemorragic state
*Hoyt ,Richard,Simons , Robert ,Winchell , James;
J Trauma 1993: Vol 35; 525 -528

6. CRITERIA FOR DIAGNOSIS
 SEPTICEMIA - Blood culture
Leucocytosis
Thrombocytopenia
 DIABETES INSIPIDUS - Polyuria, polydipsia
Ur.volume: 8-16L/Day
Ur.osm : <600mosm/kg
Pl.osm : >300mosm/kg.
 HYPOVOLEMIA - Hypotension, Tachycardia

7. NON ORTHOPAEDIC COMPLICATIONS
 HYPOVOLEMIA - 92 (95.8%)
 ARDS - 9 (9.4 %)
SEPTICEMIA - 8 (8.3%)
 PE - 6 (6.3%)
 DIC - 4 (4.2%)
 DIABETES INSIPIDUS - 2 (2.1%)
 PNEUMONIA - 1 (1%)

8. Statistical Analysis : SPSS Software P < 0.001
ANALYSIS OF RESULTS
AGE
0
1
2
3
4
5
6
7
percentage
20- 30 yrs
31- 40 yrs
41- 50 yrs
51- 60 yrs
ARDS PE DIC SEPTI PNEUMO D.INSIP

9. ANALYSIS OF RESULTS
Statistical Analysis : SPSS Software P < 0.001
SEX
0
2
4
6
8
10
percentage
MALE
FEMALE
ARDS PE DIC PNEUMOSEPT D. INSIP

10. ANALYSIS OF RESULTS
Statistical Analysis : SPSS Software P < 0.001
MODE OF INJURY
0
1
2
3
4
5
6
7
8
9
10
percentage
PEDESTRIAN
FALL
TWO WHEELER
FOUR WHEELER
ARDS PE DIC SEPT PNEUMO D. INSIP

11. ANALYSIS OF RESULTS
Statistical Analysis : SPSS Software P < 0.001
NO. OF SKELETAL INJURIES
0
1
2
3
4
5
6
7
percentage
2 #
3#
4#
5#
ARDS PE DIC SEPTI PNEUMO D.INSIP

12. FEMUR INJURY
0
1
2
3
4
5
6
7
8
9
percentage
RIGHT
LEFT
BILATERAL
ARDS PE SEPTDIC PNEUMO D.INSIP
Statistical Analysis : SPSS Software P < 0.001
ANALYSIS OF RESULTS

13. Statistical Analysis : SPSS Software P < 0.001
ANALYSIS OF RESULTS
* Pape HC et al, Unfallchirurg 2003 feb 106: 87 –96

14. Statistical Analysis : SPSS Software P < 0.001
ANALYSIS OF RESULTS
REVISED TRAUMA SCORE
0
1
2
3
4
5
6
7
8
9
10
% OF PATIENTS
MEAN
ARDS PE DIC SEPT PNEUMO D.INSIP
RTS

15. CONCLUSION
 More the no. of skeletal injuries, more is the
incidence of non-orthopaedic complications
 Risk factors are
Middle aged males
Two wheeler accidents
RTS < 6
Delay in surgery
Bilateral femoral fractures
 Damage control orthopaedics helps in