A multidisciplinary approach is essential for trauma patients’ treatment, particularly for cases with open lower extremity fractures, which are considered major traumas requiring a comprehensive approach. Recently, the social demand for severe-trauma centers has increased. This study analyzed the clinical impact of establishing a trauma center for the treatment of open lower extremity fractures. A retrospective chart review was conducted for trauma patients admitted to our hospital. Patients were classified into two groups: before (January 2014–December 2015, 178 patients) and after establishment of a Level-1 trauma center (January 2017–December 2018, 125 patients). We included patients with open fracture below the knee level and Gustilo type II/III, but excluded those with life-threatening trauma that affected the treatment choice. Total 273 patient were included in this study, initial infection was significantly more common and external fixator application significantly less in post-center establishment group. The time to emergency operation decreased significantly from 13.89 ± 17.48 to 11.65 ± 19.33 h post-center setup. By multivariate analysis, the decreased primary amputation and increased limb salvage was attributed to establishment of the trauma center. With the establishment of the Level-1 trauma center, limbs of patients with open lower extremity fractures could be salvaged, and the need for primary amputation was decreased. Early control of initial open wound infection and minimizing external fixator use allowed early soft tissue reconstruction. The existence of the center ensured a shorter interval to emergency operation and facilitated interdepartmental cooperation, which promoted active limb salvage and contributed to patients’ quality of life.

中文翻译：

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建立下肢创伤一级创伤中心的影响：4年经验

多学科方法对于创伤患者的治疗至关重要，特别是对于开放性下肢骨折病例，这些病例被认为是需要综合治疗的重大创伤。近期，社会对重症创伤中心的需求有所增加。本研究分析了建立创伤中心治疗开放性下肢骨折的临床影响。我们对入院的创伤患者进行了回顾性图表审查。患者分为两组：1级创伤中心成立前（2014年1月-2015年12月，178名患者）和一级创伤中心成立后（2017年1月-2018年12月，125名患者）。我们纳入了膝关节以下开放性骨折和 Gustilo II/III 型患者，但排除了影响治疗选择的危及生命创伤的患者。本研究共纳入 273 名患者，在中心后建立组中，初始感染明显更常见，外固定器应用明显更少。紧急操作的时间从中心设置后的 13.89 ± 17.48 显着减少到 11.65 ± 19.33 小时。多因素分析表明，原发性截肢减少和保肢量增加归因于创伤中心的建立。随着一级创伤中心的建立，开放性下肢骨折患者的肢体得到抢救，减少了原发性截肢的需要。对初始开放性伤口感染的早期控制和尽量减少外固定器的使用使早期软组织重建成为可能。