Background: We reviewed the orthopedic intervention in patients with blunt aortic injury over a 17-year period retrospectively, in order to evaluate the impact of aortic treatment options under the situation of concomitant orthopedic injuries.

Materials and methods: Information on demographics, mechanisms of trauma, injury scores, diagnostic tools, orthopedic procedures, aortic procedures, associated injuries, and hospital events was collected retrospectively from a tertiary trauma center. We applied t test for continuous data, X2 test for categorical data, and nonparametrical tests for data not following normal distribution. Adjusted hazard ratio, 95% confidence intervals, and p-values were derived from previously analyzed results.

Results: Between October 1995 and June 2012, there were 59 (59/88, 67%) patients with concomitant fractures among 88 patients, who have been proven to have blunt traumatic aortic injury (BTAI) in our institution. Among them, 31 underwent no orthopedic procedure (group I), and 28 received orthopedic fixation for functional restoration (group II). Among the two groups, group I had higher mortality rate despite an earlier documentation of aortic lesions at arrival.
For the patients in group II, 13 of them have received open aortic surgery and 6 of them have received endovascular aortic repair while the rest of the patients had minor BTAI, who were not indicated for invasive treatment. We compared demographic data, prognosis, and the timing of orthopedic procedures after aortic repair of patients with open aortic surgery (n = 13) and endovascular aortic repair (n = 6) to evaluate the impact of different aortic managements on these parameters. There was no difference between gender, age, injury severity, death, interval between injury to emergency room (ER), interval of trauma to orthopedic procedures, ER, intensive care unit and hospital stay. Nonetheless, patients treated with endovascular aortic repair tended to receive orthopedic procedure earlier after aortic intervention in comparison with those with open aortic surgery (2.2 ± 2.6 vs 6.9 ± 5.7 days, p = 0.03).

Conclusion: Patients with multiple traumas including BTAI had better outcome when they could be treated for aortic lesions operatively. Patients with BTAI who were treated with endovascular method tended to receive faster orthopedic corrections in comparison with patients who were treated with open aortic surgery.

Keywords: Blunt aortic injury, Endovascular, Fracture, Orthopedic, Trauma.

How to cite this article: Kao CC, Chen SW, Huang YC, Huang YK, Tsai FC, Lin PJ. Orthopedic Operations in Blunt Traumatic Aortic Injury: Surgical Timing and Impact of Endovascular Aortic Repair. Panam J Trauma Crit Care Emerg Surg 2018;7(1):38-46.

Source of support: This study was supported in part by the National Science Council of the Republic of China, Taiwan (Contract Nos. 103-2314-B-182A-073-MY2) and the Chang- Gung Memorial Hospital (Contract Nos. CMRPG6C0341 and CMRPG380841).

Conflict of interest: None