Timing in orthopaedic surgery - Rethinking traditional myths with a critical perspective.

作者：J. Reinhard, Melanie Schindler, Josina Straub, Baertl Susanne, D. Szymski, N. Walter, Siegmund Lang, Volker Alt, Markus Rupp · 发表于：Injury · 年份：2025 · DOI：10.1016/j.injury.2025.112165 · 被引用次数：7 · 研究领域：Medicine

PURPOSE Standard operating procedures aim to achieve a standardized and assumedly high-quality therapy. However, in orthopaedic surgery, the aspect of temporal urgency is often based on surgical tradition and experience. At a time of evidence-based medicine, it is necessary to question these temporal guidelines. The following review will therefore address the most important temporal guidelines in orthopaedic surgery and discuss their practical relevance and potential need for optimization. METHODS The systematic review features a literature review by database search in "PubMed" (https://pubmed.ncbi.nlm.nih.gov) for time to surgery in terms of (1) "proximal femoral fractures", (2) "femoral neck fractures", (3) "proximal humeral fractures", (4) "ligament and tendon injuries", (5) "spinal cord injuries", (6) "open fractures" and (7) "fracture-related infections". For every diagnosis, hypotheses on timing were set up and checked for evidence. RESULTS There is solid clinical evidence supporting the initiation of treatment within 24 h for specific conditions like the surgical treatment of proximal femur fractures and prompt decompression of spinal cord injuries. However, for other scenarios such as the 6-hour rule for open fractures, joint-preserving femoral neck fractures, timing of ligament injuries, humeral head fractures and fracture-related infections there is currently no reliable evidence to guide prompt surgical treatment. CONCLUSION Based on the current data, resourc...