The train crash resulted in severe multiple trauma fractures in 78 cases, with four reported deaths. Limb fractures were recorded in 78 cases, totaling 132 fractures, with each patient having at least one and up to four fractures. Among these, there were 30 femoral shaft fractures, eight intertrochanteric fractures, 32 tibia and fibula fractures, six ankle fractures, 24 humeral shaft fractures, seven supracondylar humerus fractures, and 25 ulnar and radial fractures. Closed fractures accounted for 79 (59.8%), while open fractures were 53 (40.2%). Admission systolic blood pressure ranged from 0 to 11.6kPa, averaging 7.4kPa. The severity was evaluated using the ISS method, scoring between 18 and 55, with an average of 27.13. Treatment included anti-shock therapy to stabilize the condition or surgery to address life-threatening organ injuries. Brain injury hematomas required surgery in 37 cases, thoracotomy and closed drainage in 14 cases, and laparotomy in 27 cases. Of the 132 limb fractures, simultaneous or subsequent internal fixation was performed (intramedullary nail in 39 cases, Ender-pin in 27 cases, steel plate in 23 cases, hip screw in six cases, Kirschner needle, wire, and other methods in 37 cases).
Results: All four patients died from severe brain injuries. One case of fracture infection was brought under control after treatment. Two cases of nonunion were cured after a second surgery. Five cases of joint dysfunction occurred (three due to traumatic brain injury and coma, leading to untimely functional exercise; two caused by joint fractures). This group of patients did not experience pneumonia, atelectasis, fat embolism, pressure ulcers, venous thrombosis, or secondary vascular nerve injury.
Discussion: In the Second Hospital of Sanming City Eastern Hospital, located in Yong’an, whether severe multiple trauma fracture patients should undergo emergency surgery and internal fixation hinges on surgical risk. Traditional medicine advocates conservative or delayed surgical treatment due to perceived risks, but timely fixation of fractures can prevent additional local soft tissue damage, secondary nerve and vessel damage, impaired fracture healing due to blood supply disruption, unrelieved pain, increased patient suffering, difficulty correcting shock, bedridden complications such as pressure sores, pneumonia, fat embolism, and lower limb venous thrombosis. Unfixed fractures also complicate the handling of other organ injuries, making examinations, treatments, and care more difficult. Conservative treatment does not reduce complications or mortality but adds many difficulties to treatment and care.
Browner's study confirmed that early surgery significantly reduces disability and the incidence of serious complications like fat embolism and ARDS, greatly improving survival rates and promoting brain function recovery when ISS scores are similar. Emergency and internal fixation of multiple trauma fractures offers several advantages: first, it occurs when the patient's body is nourished, providing a good surgical window; thorough debridement and lavage of open fractures effectively prevent wound infections; easy and fresh reduction and fixation result in high anatomical reduction rates, less time-consuming procedures, minimal invasiveness, and early functional exercises that help prevent bedsores and promote lung ventilation and gastrointestinal function recovery, preventing complications. Especially for agitated patients with traumatic brain injuries, fixing fractures has significant meaning, preventing secondary injuries from displacement and ensuring normal fracture healing, reducing mortality.
Given the perilous conditions resulting from train crashes causing multiple injuries, early fracture fixation should be simple, strong, and solid, supplemented by intramedullary and extramedullary fixation; backbone fixation-based, supplemented by small fractures. The primary treatment principle remains saving lives first, immediately addressing severe brain injuries, chest massive bleeding, abdominal organ hemorrhages, and hollow organ ruptures. These injuries are not contraindications for main shaft fracture fixation. Completing these procedures while managing anti-shock under anesthesia timely restores anatomical relationships and shortens anesthesia and surgery processes, reducing trauma and inflammatory reactions, undoubtedly accelerating rehabilitation and reducing disability.
We realize the importance of avoiding two tendencies: First, neglecting early fracture treatment until other organs heal, leading to orthopedic consultations, which can result in heavier disabilities or even ARDS, fat embolism, and shock; meeting in fracture diagnosis and treatment, overlooking organ injuries, a perilous mistake to save time, leading to serious consequences.