________________________________________	 
 	Learning Track:	10. Critical Emergency Medicine - Trauma and Resuscitation
Title:	Predictive value of IL-1 and IL-6 in polytrauma patients with femoral fractures
Author(s):	Lupescu D.1, Dimitriu A.2, Nagea M.3, Greabu M.4, Lupescu O.2
Institute(s):	1Buftea Hospital, Dept. of Anaesthesiology & Intensive Care, Buftea, Romania, 2University of Medicine and Pharmacy ' Carol Davila', Orthopaedics and Traumatology, Bucharest, Romania, 3Clinical Emergency Hospital, Orthopaedics and Traumatology, Bucharest, Romania, 4University of Medicine and Pharmacy ' Carol Davila', Biochemistry, Bucharest, Romania
Text:	Background and Goal of Study: 
Polytrauma patients with femoral fractures are high energy injuries with significant impact upon the homeostasis. Early stabilization of the fracture is a resuscitative measure and two methods are used: Early Total Care (ETC) - primary nailing, or Damage Control (DC) - initial external fixator, then nailing, so as to avoid the second hit phenomenon. The purpose of this paper is to evaluate if using IL-1 and IL-6 as guiding markers for treatment can increase the efficacy of the orthopaedic unit in polytrauma patients
This study included 66 polytrauma patients with femoral fractures operated between 01.01.2014-01.01.2016 in the Clinical Emergency Hospital Bucharest, divided into group A- 38 patients, ETC and 28 patients- group B, with DC. The following inflammation tests were monitored: white blood cell count, ESR, fibrinogen, C reactive protein, IL-1 and IL-6.The evaluation criteria were: hospital stay, rates of MSOF and ARDS and local complications 
Results and discussion: 
The hospital stay was not influenced by the method of stabilization, but by the life threatening injuries and their evolution . Patients from DC group had a smaller rate of MSOF and ARDS even if they had had higher traumatic scores. External fixation followed by intramedullary nailing was not associated with higher rate of complications than primary nailing (ETC) 
The analysis of the data revealed that multidisciplinary team application of DC lead to a lower incidence of complications (although without statistical significance) Acute inflammation tests were correlated with the outcome, and IL 1 and IL 6 had the best capacity to predict complications. In patients where definitive stabilization was performed only after the remission of the inflammatory syndrome, the rate of complications was much lower. 
Conclusions: ETC or DC can be used for femoral stabilisation in polytrauma patients, so as to void the second hit phenomenon. IL-1 and IL-6 can be used in choosing the less invasive pathway and to monitor the patients, so as to decrease mortality and morbidity. This study underlines the necessity of standardised use of these biochemical markers in current practice for increasing the efficacy of the multidisciplinary team in polytrauma patients
References: 
H. C. Pape et al, “Timing of fixation of major fractures in blunt polytrauma: role of conventional indicators in clinical decision making,” Journal of Orthopaedic Trauma,2005 (19): 8:551-562
Ethical Research Declaration:	10. Service Evaluation
Preferred Presentation Type:	Clinical or experimental study