Prognóstico de pacientes com fratura de fêmur e pelve: férula de tração vs controle de danos

Abstract

Introduction: Fractures of the femur and pelvis are very common both in the young population and in the elderly population, caused by different mechanisms, from automobile accidents to the various forms of falls. The treatment of these fractures is aimed at minimizing the associated morbidities and the complete and functional recovery of the patient, since they rarely lead to death. Objective: To compare the prognosis of patients with fractures of the femur and pelvis undergoing treatment with a traction template and damage control. Methodology: The present study was developed through a quantitative observational study, based on data from medical records of patients hospitalized at the Orthopedics and Traumatology Service of Hospital de Clínicas de Passo Fundo, with fractures of the femur and pelvis, which were treated with a traction or damage control between January 1, 2000 to December 31, 2016. Results: 82 patients were included in the study, 67.1% of whom were treated with a traction template and 32.9% with the damage control method. It was found that those who received treatment with traction template were more likely to develop fat embolism (38%, p = 0.02) and pneumonia (33% p = 0.04). However, when the adjusted analysis was carried out, taking into account confounding factors, only fat embolism (39% p = 0.03) remained more prevalent in the group that received the traction template when compared to the damage control. When comparing the type of treatment with the length of hospital stay, 62.9% of the patients remained in hospital for 6 to 10 days in terms of damage control, while those treated with traction template, 36.4% of the patients remained hospitalized for 6 to 10 days, followed by up to 5 days (21.8%) and 18.2% between 11 and 15 days. Conclusion: Based on this study, we found that those who received treatment with traction template were more likely to develop fat embolism than those who underwent damage control. Thus, they developed a worse prognosis, as fat embolism increases the chances of pulmonary and cerebral involvement. Contrary to what was expected from this study, both treatments were equivalent in terms of length of hospital stay, thus not being a predictive factor for a poor prognosis, associated with fat embolism.