Major emergency orthopaedic surgery in patients with a concomitant acute coronary event following trauma

Int Orthop. 2019 Aug;43(8):1793-1798. doi: 10.1007/s00264-018-4163-9. Epub 2018 Oct 1.

Abstract

Introduction: This paper is a short series description of our experience with five cases managed surgically for orthopaedic trauma and who suffered meanwhile an acute coronary event.

Materials and methods: Five polytrauma, multiply fractured patients were treated in our institution for various lesions, including an open femur and knee articular fractures, major fractures around the pelvis and hips. They had suffered around the same time an acute coronary event complicating the orthopaedic management. One patient was treated for the orthopaedic condition as a delayed emergency, with a five day retard due to pre-operative pulmonary oedema. Four patients had cardiac evaluation, angiogram or echocardiogram. The patients were managed by a multi-disciplinary team.

Results: One patient died post-operatively due to multiple complications, and four patients survived with a good functional outcome.

Conclusions: Patients with acute orthopaedic polytrauma presenting concomitant acute coronary events should be treated by multi-disciplinary teams, allowing early surgical management in a safe cardio-vascular and stable haemodynamic status.

Keywords: Acute coronary event; Cardiac ischaemia; Heart; Myocardial infarction; Open fracture; Orthopaedic trauma; Pelvis fracture.

MeSH terms

  • Acute Coronary Syndrome / complications
  • Acute Coronary Syndrome / therapy
  • Adult
  • Aged
  • Emergencies
  • Female
  • Fractures, Bone / complications
  • Fractures, Bone / surgery*
  • Humans
  • Male
  • Middle Aged
  • Multiple Trauma / complications
  • Multiple Trauma / surgery
  • Myocardial Ischemia / complications*
  • Myocardial Ischemia / therapy
  • Orthopedic Procedures*
  • Patient Care Team
  • Wounds and Injuries / complications
  • Wounds and Injuries / surgery