Journal de traumatisme et de traitement

Orthopaedic Patients Who Require Intensive Care Admission

Abstract

Surya Gandham

The purpose of this study is to evaluate the causes, numbers, demographics and outcomes of all trauma and elective patients admitted under orthopaedic care but needed intensive care input during their inpatient stay. A retrospective case note study looking at all trauma patients admitted between January 2009 and August 2010 from a University Teaching Hospital that needed ITU admission during their inpatient stay. ITU records were cross matched with an orthopaedic trauma database to create a list of patients. 43 trauma patients were admitted to ITU from orthopaedic care during this 19 month period. These patients were then split into three categories 1) Trauma patients (one fracture) 2) Poly trauma patients (<2 fractures) 3) Transfers (Inter-hospital transfers). Within the “trauma” patients’ category, 25% of patients were admitted due to post-operative complications following hip hemi-arthroplasties, 17% due to wound debridement and soft tissue infection and 14% attributed to post-oprative complications following IMHS fixation. 30% of patients needed ITU input due to sepsis, 19% due to acute renal failure and 17% to respiratory failure.11 patients were categorised as “poly-trauma” patients. 55% of patients sustained a RTA whilst the rest were split between “fall from height” and “crush” injuries. 34% of these patients needed ventillatory support and inotropes. The mortality rate was highest and the length of stay in ITU was longer in the “trauma” cohort, 21% and 4 days respectively.Largest proportion of ITU admissions were due to post operative complications following hip surgery especially hemi-arthroplasties. However, a surprising group that emerged was the number of patients admitted to ITU who had metal work and soft tissue infections. This has highlighted the need for pre-operative optimisation and post-operative vigilance in patients with orthopaedic infections and hip fractures.