Evaluating Early Appropriate Care Criteria for Acute Axial and Lower Extremity Fractures: A Large Database Propensity-Matched Cohort Study.

OBJECTIVES: To evaluate the validity of Early Appropriate Care (EAC) criteria for managing unstable fractures of the spine, femur, and pelvis using a large database of patients. METHODS: Those ≥18 years old with spine, pelvis, or femur fractures presenting to the emergency department with hemodynamic instability requiring resuscitation were included. Polytrauma patients with other significant injuries were excluded. Complications in the immediate (7, 14, and 30 days) and intermediate (90, 180, and 365 days) postoperative period were evaluated. RESULTS: A total of 4115 adult orthopaedic trauma patients met EAC resuscitation criteria: 2,783 patients (68%) underwent definitive fixation within 48 hours and 1,332 (32%) after 48 hours. After propensity matching, both cohorts consisted of 1,317 patients with similar demographics and medical comorbidities. Patients who underwent definitive fixation within 48 hours were at lower risk of deep vein thrombosis, pulmonary embolism, deep infection, sepsis, and death in the intermediate postoperative period (P < 0.05 for all). CONCLUSION: EAC of spine, pelvis, or femur fractures following adequate resuscitation is associated with lower rates of deep vein thrombosis, pulmonary embolism, sepsis, and death in the early and intermediate postoperative period. Age-stratified analysis found younger cohorts were less likely to have myocardial infarction or stroke, along with lower mortality rates across multiple time points. These data highlight the importance of early definitive fixation of adequately resuscitated orthopaedic trauma patients, validating the findings of previous studies through a large, international database.