{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T01:03:14Z","timestamp":1793754194563,"version":"4.6.1"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,2,7]],"date-time":"2025-02-07T00:00:00Z","timestamp":1738886400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,2,7]],"date-time":"2025-02-07T00:00:00Z","timestamp":1738886400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100007210","name":"RWTH Aachen University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100007210","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Trauma Emerg Surg"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The optimal timing for definitive surgical treatment of pelvic fractures in polytrauma patients remains a topic of ongoing discussion due to the complexity of these injuries. This analysis therefore aims to systematically compare early versus late definitive operative stabilization of pelvic fractures on outcome in polytrauma patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>PubMed, CENTRAL and Web of Science were systematically searched to identify relevant completed and ongoing studies from the inception of each database to March 13, 2023. Systematic reviews, randomized control trials (RCTs) and observational studies comparing early (&lt;\u200924\u00a0h) versus late (&gt;\u200924\u00a0h) definitive operative stabilization in adult polytrauma patients admitted to the ICU were included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Since no systematic reviews and RCTs were available on this subject, one observational study was identified, including a total of 418 polytrauma patients (n\n                      <jats:sub>early<\/jats:sub>\n                      = 165, n\n                      <jats:sub>late<\/jats:sub>\n                      = 253), median age: 40.3 years (early 40.1 years, late 40.4 years). Early definitive stabilization was associated with a decreased risk of acute respiratory distress syndrome (ARDS) compared to late stabilization of unstable pelvis and acetabulum fractures (RR 0.38, 95% CI 0.18\u20130.81; RD 78 fewer per 1000, 95% CI 104 fewer to 24 fewer; 1 study, 418 participants; very low certainty of evidence). Furthermore, early definitive stabilization may decrease the risk of pneumonia compared to late stabilization of unstable pelvis and acetabulum fractures (RR 0.50, 95% CI 0.28\u20130.88; RD 85 fewer per 1000, 95% CI 122 fewer to 20 fewer); 1 study, 418 participants; very low certainty of evidence).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>There is limited evidence regarding early definitive fracture repair (\u2264\u200924\u00a0h) compared to late repair of pelvic fractures in polytrauma patients. One observational study showed a reduced incidence of septic respiratory complications, ARDS, and multi-organ failure (MOF) in polytrauma patients who received early definitive fracture repair.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00068-025-02774-1","type":"journal-article","created":{"date-parts":[[2025,2,7]],"date-time":"2025-02-07T09:33:15Z","timestamp":1738920795000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["The optimal timing for definitive operative stabilization of pelvic fractures in polytrauma patients: effects on clinical outcomes \u2013 a systematic review"],"prefix":"10.1007","volume":"51","author":[{"given":"Julia","family":"Dormann","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klemens","family":"Horst","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karolina","family":"Dahms","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Steinfeld","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"Ansems","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidrun","family":"Janka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria-Inti","family":"Metzendorf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Breuer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carina","family":"Benstoem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Hildebrand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eftychios","family":"Bolierakis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,2,7]]},"reference":[{"issue":"10","key":"2774_CR1","doi-asserted-by":"publisher","first-page":"832","DOI":"10.1007\/s00113-010-1772-1","volume":"113l\u2013","author":"T L\u00f6gters","year":"2010","unstructured":"L\u00f6gters T, Lefering R, Schneppendahl J, Alldinger I, Witte I, Windolf J, et al. Abbruch Der Schockraumdiagnostik Und Notfalloperation Beim Polytrauma \u2013 Inzidenz und klinische Relevanz. Der Unfallchirurg. 2010;113l\u2013(10):832\u20138.","journal-title":"Der Unfallchirurg"},{"issue":"4","key":"2774_CR2","doi-asserted-by":"publisher","first-page":"935","DOI":"10.1097\/TA.0b013e3181d27b48","volume":"68","author":"N Enninghorst","year":"2010","unstructured":"Enninghorst N, Toth L, King KL, McDougall D, Mackenzie S, Balogh ZJ. Acute definitive internal fixation of pelvic ring fractures in polytrauma patients: a feasible option. J Trauma Acute Care Surg. 2010;68(4):935\u201341.","journal-title":"J Trauma Acute Care Surg"},{"issue":"7","key":"2774_CR3","doi-asserted-by":"publisher","first-page":"468","DOI":"10.1097\/00005131-200109000-00002","volume":"15","author":"W Ertel","year":"2001","unstructured":"Ertel W, Keel M, Eid K, Platz A, Trentz O. Control of severe hemorrhage using C-Clamp and pelvic packing in multiply injured patients with pelvic ring disruption. J Orthop Trauma. 2001;15(7):468\u201374.","journal-title":"J Orthop Trauma"},{"key":"2774_CR4","doi-asserted-by":"crossref","unstructured":"Cimbanassi S, O\u2019Toole R, Maegele M, Henry S, Scalea TM, Bove F et al. Orthopedic injuries in patients with multiple injuries: results of the 11th trauma update international consensus conference Milan, December 11, 2017. Journal of Trauma and Acute Care Surgery. 2020;88(2):e53-e76.","DOI":"10.1097\/TA.0000000000002407"},{"issue":"1","key":"2774_CR5","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.injury.2004.05.029","volume":"36","author":"MRW Grotz","year":"2005","unstructured":"Grotz MRW, Allami MK, Harwood P, Pape HC, Krettek C, Giannoudis PV. Open pelvic fractures: epidemiology, current concepts of management and outcome. Injury. 2005;36(1):1\u201313.","journal-title":"Injury"},{"issue":"4","key":"2774_CR6","doi-asserted-by":"publisher","first-page":"778","DOI":"10.1097\/01.TA.0000158251.40760.B2","volume":"58","author":"Z Balogh","year":"2005","unstructured":"Balogh Z, Caldwell E, Heetveld M, D\u2019Amours S, Schlaphoff G, Harris I, et al. Institutional practice guidelines on management of pelvic fracture-related hemodynamic instability: do they make a difference? J Trauma Acute Care Surg. 2005;58(4):778\u201382.","journal-title":"J Trauma Acute Care Surg"},{"issue":"4","key":"2774_CR7","doi-asserted-by":"publisher","first-page":"761","DOI":"10.1016\/S0039-6109(05)70582-X","volume":"77","author":"MF Rotondo","year":"1997","unstructured":"Rotondo MF, Zonies DH. The damage control sequence, and underlying logic. Surg Clin North Am. 1997;77(4):761\u201377.","journal-title":"Surg Clin North Am"},{"issue":"11","key":"2774_CR8","doi-asserted-by":"publisher","first-page":"941","DOI":"10.1016\/j.asjsur.2019.01.004","volume":"42","author":"TH Kim","year":"2019","unstructured":"Kim TH, Yoon YC, Chung JY, Song HK. Strategies for the management of hemodynamically unstable pelvic fractures: from preperitoneal pelvic packing to definitive internal fixation. Asian J Surg. 2019;42(11):941\u20136.","journal-title":"Asian J Surg"},{"issue":"2","key":"2774_CR9","doi-asserted-by":"publisher","first-page":"292","DOI":"10.1016\/j.injury.2022.11.008","volume":"54","author":"R Pfeifer","year":"2023","unstructured":"Pfeifer R, Klingebiel FK-L, Halvachizadeh S, Kalbas Y, Pape H-C. How to clear polytrauma patients for fracture fixation: results of a systematic review of the literature. Injury. 2023;54(2):292\u2013317.","journal-title":"Injury"},{"issue":"10","key":"2774_CR10","doi-asserted-by":"publisher","first-page":"1656","DOI":"10.1016\/j.injury.2019.09.021","volume":"50","author":"HC Pape","year":"2019","unstructured":"Pape HC, Halvachizadeh S, Leenen L, Velmahos GD, Buckley R, Giannoudis PV. Timing of major fracture care in polytrauma patients \u2013 an update on principles, parameters and strategies for 2020. Injury. 2019;50(10):1656\u201370.","journal-title":"Injury"},{"issue":"1","key":"2774_CR11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.injury.2014.12.001","volume":"46","author":"HC Pape","year":"2015","unstructured":"Pape HC, Pfeifer R. Safe definitive orthopaedic surgery (SDS): repeated assessment for tapered application of early definitive care and damage control? An inclusive view of recent advances in polytrauma management. Injury. 2015;46(1):1\u20133.","journal-title":"Injury"},{"key":"2774_CR12","first-page":"249","volume":"37","author":"H Tscherne","year":"1966","unstructured":"Tscherne H. The treatment of the severly injured at an emergency station. Chirurg. 1966;37:249\u201352.","journal-title":"Chirurg"},{"issue":"1","key":"2774_CR13","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1186\/s13643-016-0384-4","volume":"5","author":"M Ouzzani","year":"2016","unstructured":"Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan\u2014a web and mobile app for systematic reviews. Syst Reviews. 2016;5(1):210.","journal-title":"Syst Reviews"},{"key":"2774_CR14","unstructured":"Microsoft Corporation. (2018). Microsoft Excel [Version 2018]."},{"key":"2774_CR15","unstructured":"Review Manager (RevMan). Version 5.3. The Cochrane Collaboration. 2020. Available at revman.cochrane.org."},{"key":"2774_CR16","doi-asserted-by":"publisher","first-page":"i4919","DOI":"10.1136\/bmj.i4919","volume":"355","author":"JA Sterne","year":"2016","unstructured":"Sterne JA, Hern\u00e1n MA, Reeves BC, Savovi\u0107 J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919.","journal-title":"BMJ"},{"key":"2774_CR17","unstructured":"GRADEpro Guideline Development Tool. McMaster University and Evidence Prime. 2023. Available at gradepro.org."},{"issue":"3","key":"2774_CR18","first-page":"677","volume":"69","author":"HA Vallier","year":"2010","unstructured":"Vallier HA, Cureton BA, Ekstein C, Oldenburg FP, Wilber JH. Early definitive stabilization of unstable pelvis and acetabulum fractures reduces morbidity. J Trauma. 2010;69(3):677\u201384.","journal-title":"J Trauma"},{"issue":"5","key":"2774_CR19","doi-asserted-by":"publisher","first-page":"840","DOI":"10.1177\/00031348211056266","volume":"88","author":"NA Taylor","year":"2022","unstructured":"Taylor NA, Smith AA, Marr A, Stuke L, Greiffenstein P, Schoen J, et al. Does time to pelvic fixation influence outcomes in trauma patients? Am Surgeon\u2122. 2022;88(5):840\u20135.","journal-title":"Am Surgeon\u2122"},{"issue":"4","key":"2774_CR20","doi-asserted-by":"publisher","first-page":"730","DOI":"10.1097\/TA.0000000000002860","volume":"89","author":"GL Devaney","year":"2020","unstructured":"Devaney GL, Bulman J, King KL, Balogh ZJ. Time to definitive fixation of pelvic and acetabular fractures. J Trauma Acute Care Surg. 2020;89(4):730\u20135.","journal-title":"J Trauma Acute Care Surg"},{"issue":"2","key":"2774_CR21","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1016\/j.injury.2012.08.062","volume":"44","author":"B Grey","year":"2013","unstructured":"Grey B, Rodseth RN, Muckart DJ. Early fracture stabilisation in the presence of subclinical hypoperfusion. Injury. 2013;44(2):217\u201320.","journal-title":"Injury"},{"issue":"4","key":"2774_CR22","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1097\/BOT.0000000000001946","volume":"35","author":"DG Rojas","year":"2021","unstructured":"Rojas DG, Coleman JR, Moore EE, Dean CS, Parry JA, Elrick BP, et al. The association of surgical timing and injury severity with systemic complications in severely injured patients with pelvic ring injuries. J Orthop Trauma. 2021;35(4):171\u20134.","journal-title":"J Orthop Trauma"},{"issue":"2","key":"2774_CR23","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1016\/S0020-1383(99)00233-8","volume":"31","author":"BR Plaisier","year":"2000","unstructured":"Plaisier BR, Meldon SW, Super DM, Malangoni MA. Improved outcome after early fixation of acetabular fractures. Injury. 2000;31(2):81\u20134.","journal-title":"Injury"},{"issue":"1\u20132","key":"2774_CR24","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1007\/BF01402180","volume":"102","author":"Z Kotwica","year":"1990","unstructured":"Kotwica Z, Balcewicz L, Jagodzi\u0144ski Z. Head injuries coexistent with pelvic or lower extremity fractures\u2013early or delayed osteosynthesis. Acta Neurochir (Wien). 1990;102(1\u20132):19\u201321.","journal-title":"Acta Neurochir (Wien)"},{"issue":"1","key":"2774_CR25","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1097\/00005373-199101000-00006","volume":"31","author":"BA Latenser","year":"1991","unstructured":"Latenser BA, Gentilello LM, Tarver AA, Thalgott JS, Batdorf JW. Improved outcome with early fixation of skeletally unstable pelvic fractures. J Trauma. 1991;31(1):28\u201331.","journal-title":"J Trauma"},{"issue":"2","key":"2774_CR26","first-page":"370","volume":"62","author":"C Probst","year":"2007","unstructured":"Probst C, Probst T, Gaensslen A, Krettek C, Pape HC. Timing and duration of the initial pelvic stabilization after multiple trauma in patients from the German trauma registry: is there an influence on outcome? J Trauma. 2007;62(2):370\u20137. discussion 6\u20137.","journal-title":"J Trauma"}],"container-title":["European Journal of Trauma and Emergency Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00068-025-02774-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00068-025-02774-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00068-025-02774-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T11:07:22Z","timestamp":1770721642000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00068-025-02774-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,7]]},"references-count":26,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["2774"],"URL":"https:\/\/doi.org\/10.1007\/s00068-025-02774-1","relation":{},"ISSN":["1863-9933","1863-9941"],"issn-type":[{"value":"1863-9933","type":"print"},{"value":"1863-9941","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,7]]},"assertion":[{"value":"24 October 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 January 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 February 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"100"}}