Rehabilitation Outcomes Following Simultaneous Orthopaedic Fracture Fixation and Abdominal Surgery: A Prospective Observational Study

Dr. Jebin Levi J, et al. Rehabilitation Outcomes Following Simultaneous Orthopaedic Fracture Fixation and Abdominal Surgery: A Prospective Observational Study. Int. J Med. Pharm. Res., 6 (6): 81‐94, 2025 81 International Journal of Medical and Pharmaceutical Research Online ISSN-2958-3683 | Print ISSN-2958-3675 Frequency: Bi-Monthly Available online on: https://ijmpr.in/ Original Article Rehabilitation Outcomes Following Simultaneous Orthopaedic Fracture Fixation and Abdominal Surgery: A Prospective Observational Study Dr. Jebin Levi J1, Dr. Logesh Kumar R1, Dr. T Rahul Rajan Mathews1, Dr.Jeff Walter Rajadurai OR2, Dr. Ebisheen N3, Dr. Pooja S4 1Assistant Professor, Department of General Surgery, Madha Medical College and Research Institute 2Associate Professor, Department of Orthopaedics, Madha Medical College and Research Institute 3Junior Resident, Department of General Surgery, Madha Medical College and Research Institute 4Junior Resident, Department of General Medicine, Madha Medical College and Research Institute A B S T R A C T Corresponding Author: Dr. Jeff Walter Rajadurai OR Associate Professor, Department of Orthopaedics, Madha Medical College and Research Institute Received: 01-09-2025 Accepted: 19-10-2025 Available online: 08-11-2025 Background: Simultaneous orthopaedic fracture fixation and abdominal surgery provide significant rehabilitation challenges due to physiological stress, delayed mobility, and the risk of complications. Damage-control orthopaedics (DCO) and accelerated recovery after surgery (ERAS) regimens have individually enhanced outcomes; however, evidence supporting their concurrent application in multisystem trauma remains scarce. This study aimed to evaluate the functional and rehabilitative outcomes of persons undergoing concurrent orthopaedic and gastrointestinal procedures during a single hospitalisation. Methods: A prospective observational study was conducted from March 2024 to February 2025 at a tertiary trauma centre, including 36 consecutive adult patients who received both orthopaedic fracture fixation and abdominal surgery. The Barthel Index and Short Form-36 (SF-36) were utilised to assess functional outcomes at discharge, three months, and six months. Statistical analyses included repeatedmeasures ANOVA for longitudinal trends, Pearson correlation for associations, and multivariate linear regression to identify predictors of six-month recovery. We analysed the data with IBM SPSS Version 25.0. The group was 43.97 ± 15.57 years old on average, was in the hospital for 13.86 ± 6.23 days, and took 9.58 ± 3.05 days to get up and move around. Rehabilitation began in 94.4% of the patients. Functional scores improved significantly with time: Barthel/SF-36 composite scores were 40.72 ± 12.86 (discharge), 58.86 ± 14.71 (3 months), and 73.78 ± 15.21 (6 months) (p < 0.0001). Post-hoc analysis confirmed uniform functional enhancements across intervals. Delayed union (30.6%) and infection (22.2%) were orthopaedic issues, whereas sepsis (33.3%) and ileus (22.2%) were gastrointestinal issues. There were no fatalities. Correlation and regression analyses demonstrated that no single variable (age, sex, mobilisation delay, sepsis) exerted an independent effect on recovery. Conclusion: It is both possible and safe to undertake orthopaedic and abdominal surgeries at the same time in a multidisciplinary setting that follows DCO and ERAS principles. A significant improvement in function at six months shows that well-planned early rehabilitation and coordinated postoperative care can turn surgical survival into full recovery. These findings support a unified, patientcentered methodology for the therapy of complex trauma. Copyright © International Journal of Medical and Pharmaceutical Research Keywords: Rehabilitation Outcome, Polytrauma, Enhanced Recovery After Surgery, Orthopaedic Procedures, Abdominal Injuries. INTRODUCTION One of the hardest things for modern surgeons to cope with is a significant injury that hurts both the muscles and bones and the stomach. People like this come in when they are in trouble. They have fluctuating blood pressure, are in pain, are Dr. Jebin Levi J, et al. Rehabilitation Outcomes Following Simultaneous Orthopaedic Fracture Fixation and Abdominal Surgery: A Prospective Observational Study. Int. J Med. Pharm. Res., 6 (6): 81‐94, 2025 82 terrified, and generally feel overwhelmed by the size of their injuries. The decision to intervene immediately on both fronts is a delicate line between saving a life and retaining long-term function for both the orthopaedic surgeon and the general surgeon. The individual management of abdominal trauma and skeletal fractures has advanced considerably; however, the evidence about outcomes when both treatments are performed during the same hospitalisation is markedly insufficient. Damage-control surgery and enhanced recovery after surgery (ERAS) ideas have revolutionised how individuals are cared for before, during, and after surgery in the last ten years. ERAS techniques have been demonstrated to greatly lower the risk of complications, speed up recovery, and shorten hospital stays for people with abdominal injuries by carefully emphasising on nutrition, pain control, and early mobility [1–3, 8, 9]. Similar benefits have been seen in emergency laparotomy populations, where structured preand postoperative bundles improved survival and rehabilitation results [2–4]. Even in cases of complex trauma, the careful implementation of ERAS principles has shown to be both possible and safe [8, 9]. Improvements in orthopaedic trauma have changed how fractures are treated. The shift from "early total care" to damagecontrol orthopaedics (DCO) arose from the understanding that aggressive fixation in unstable patients can exacerbate systemic inflammation and organ failure [14–18]. On the other side, putting off fixation could make it difficult to move, make you need a ventilator for longer, and boost your risk of thromboembolism. The move towards "safe definitive surgery" is an attempt to establish a middle ground between physiological stability and quick fixation, with the goal of speeding up healing without putting survival at risk [15, 16]. The real test of how well surgery works happens during rehabilitation. Early mobilisation after abdominal and orthopaedic procedures has consistently been associated with increased functional recovery, less pulmonary complications, and an enhanced quality of life [5–7, 19]. Even with these findings, there is a lack of evidence pertaining to persons undergoing concurrent fracture fixation and abdominal surgery. Pain, wound care, fluid fluctuations, and infection risk are all things that each system needs, and they all fight for clinical priority. This can sometimes make it take longer to fully recover. Nonetheless, the simultaneous occurrence of both injury types is prevalent in high-energy trauma, vehicular accidents, or falls from elevations [10–13]. The connection between systemic injury and localised recovery is not well comprehended. Do people who have more than one injury follow the same rehabilitation plan as others who just have one injury? Is it safe to start moving around again early if both the abdomen and the arms and legs have been operated on? What issues do these overlapping physical stresses cause? These queries extend beyond mere academic curiosity; they assess a patient's capacity to ambulate, participate in employment, and maintain independent living. Recognising this deficiency, the present study prospectively examines functional and rehabilitative outcomes following simultaneous orthopaedic fracture repair and abdominal surgery at a tertiary trauma facility. This study aims to clarify a facet of trauma care at the convergence of two surgical disciplines, where coordinated, patient-centered recovery is essential, by analysing objective functional ratings over successive follow-ups, with complication and survival statistics. METHODS Study Design and Setting This was a prospective observational study conducted at a tertiary trauma care facility from March 2024 to February 2025. The hospital is a regional referral clinic for severe trauma, and it treats patients who have both orthopaedic and visceral injuries. The study was authorised by the institutional ethics committee, and all participants or their designated surrogates provided informed consent. The study adhered to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines, ensuring transparency, reproducibility, and adherence to ethical standards in data collection and reporting. The design was centred on the patient. The research didn't just look at how well the surgery went. It also looked at how patients recover, how well they can walk around, how independent they feel, and how high their quality of life is, after having two procedures. Thirty-six consecutive adult patients who received simultaneous orthopaedic fracture therapy and abdominal surgery were enrolled. The requirements for inclusion were: • Young Active Adults From 18 years of age • At least one long bone or pelvic fracture needs surgery to heal. • Intra-abdominal injury necessitating concurrent surgical intervention (e.g., bowel perforation, splenic injury, or mesenteric tear). • Clinical stability to enable the concurrent performance of both procedures within a single hospital admission. • Patients with isolated orthopaedic or gastrointestinal injuries, head traumas that precluded participation in rehabilitation, or those who were lost to follow-up were excluded. Dr. Jebin Levi J, et al. Rehabilitation Outcomes Following Simultaneous Orthopaedic Fracture Fixation and Abdominal Surgery: A Prospective Observational Study. Int. J Med. Pharm. Res., 6 (6): 81‐94, 2025 83 The rationale for concurrent management derives from modern trauma protocols, in which damage-control orthopaedics (DCO) and damage-control laparotomy are coordinated to reduce systemic inflammation and promote physiological recovery [14–17]. Prior guidelines indicate that surgical priority need to be determined by haemodynamic condition and systemic response rather than isolated system urgency [10–13,16]. All patients were resuscitated following Advanced Trauma Life Support (ATLS) protocols. At initially, the patient was stabilised with fluid resuscitation, transfusion assistance, and infection prevention. Some of the abdominal surgeries were mending a hole, taking out part of the intestine and attaching it to the remainder of the bowel, taking out the spleen, fixing the mesentery, and opening the abdomen for trauma-related bleeding in the peritoneum. Orthopaedic methods included open reduction and internal fixation (nailing, plating), or external fixation if necessary. The decision between early definitive fixation and staged fixation was predicated on the patient's physiological reserve, in accordance with the "safe definitive surgery" principle [15,16]. Surgery was performed either in a single session (5.6%) or staged within 48 hours (94.4%), in accordance with international polytrauma norms [14,18]. Postoperative care followed a customised Enhanced Recovery After Surgery (ERAS) protocol designed specifically for trauma patients [1–3,8,9]. The plan had: • If possible, start enteral nutrition within 24 hours of surgery. • Multimodal pain relief that makes opioids less necessary • Beginning physiotherapy early with bedside limb movement, deep breathing exercises, and assistance in sitting up by the third to fifth day post-surgery. • As long as possible, start putting weight on it gradually over the next 2–3 weeks. Rehabilitation was multidisciplinary, involving surgeons, physiotherapists, nursing staff, and nutritionists. Daily evaluations of mobilisation goals were conducted, consistent with the principle of early ambulation following abdominal and musculoskeletal injuries, which has demonstrated efficacy in enhancing functional outcomes and reducing hospitalisations [5–7,19]. Patients were discharged from the hospital once their wounds had sufficiently healed, they were able to consume solid food, and they were capable of ambulating with or without assistance. RESULTS The information was shown as a mean, standard deviation, frequency, and percentage. We utilised Repeated Measures ANOVA to compare continuous variables. We analysed the data with IBM-SPSS version 25.0 (IBM-SPSS Science Inc., Chicago, IL). Demographic Profile A total of 36 patients who underwent simultaneous orthopaedic fracture fixation and abdominal surgery were enrolled between March and September 2024. The mean age was 43.97 ± 15.57 years, with a near-equal gender distribution (55.6 % male, 44.4 % female). The mean duration of hospital stay was 13.86 ± 6.23 days, and mobilisation commenced after an average of 9.58 ± 3.05 days, reflecting a cautious yet structured rehabilitation approach. Fracture and Surgical Characteristics The most frequent fracture sites were the radius/ulna (27.8 %), followed by the femur (19.4 %) and pelvis (19.4 %). Regarding fixation, nailing (38.9 %) was the most commonly employed method, followed by plating (33.3 %) and external fixation (27.8 %). Among abdominal procedures, repair of perforation (19.4 %), splenectomy (16.7 %), and bowel resection with anastomosis (13.9 %) were most frequent. The majority (55.6 %) underwent their second surgery within two days of the first, demonstrating a staged yet timely multidisciplinary approach. Rehabilitation Protocol Rehabilitation was initiated in 94.4 % of patients, indicating excellent adherence to postoperative physiotherapy regimens. No mortalities were reported during the study period. Functional Outcome Trends Dr. Jebin Levi J, et al. Rehabilitation Outcomes Following Simultaneous Orthopaedic Fracture Fixation and Abdominal Surgery: A Prospective Observational Study. Int. J Med. Pharm. Res., 6 (6): 81‐94, 2025 84 Functional scores, assessed by the Barthel Index and SF-36 components, demonstrated significant improvement over time. All tests were two-tailed, with p < 0.5 considered statistically significant. Time point Mean ± SD p value Discharge 40.72 ± 12.86 < 0.0001 3 months 58.86 ± 14.71 < 0.0001 6 months 73.78 ± 15.21 < 0.0001 Repeated-measures ANOVA revealed a statistically significant progressive improvement across all follow-up points (p < 0.0001). Post-hoc analyses (Bonferroni correction) showed mean score increases of 18.14 (95 % CI 16.44–19.84) from discharge to 3 months, 33.06 (95 % CI 31.32–34.79) from discharge to 6 months, and 14.92 (95 % CI 13.82–16.02) between 3 and 6 months, confirming steady rehabilitation gains with narrow confidence bands. Correlation Analysis Pearson correlation demonstrated no significant relationship between time to mobilisation and either discharge or sixmonth functional scores (r = 0.23, p = 0.19; r = 0.16, p = 0.35 respectively). This suggests that short delays in ambulation did not meaningfully affect long-term functional recovery within this cohort. Regression Analysis A multivariate linear regression model explored predictors of the six-month functional score using age, sex, time to mobilisation, length of stay, and presence of sepsis. The model explained 12 % of total variance (R² = 0.122, p = 0.54). None of the predictors reached statistical significance: Predictor β (95% Confidence Interval) p value Age (years) –0.17 (–0.53 to 0.18) 0.322 Sex (M = 1) –4.94 (–15.85 to 5.97) 0.363 Time to mobilisation (days) +0.85 (–1.00 to 2.71) 0.355 Length of stay (days) –0.35 (–1.24 to 0.53) 0.421 Sepsis (present = 1) –2.75 (–14.64 to 9.15) 0.640 No individual factor independently predicted poor outcome, implying that functional recovery likely depends on multiple inter-related physiological and rehabilitative determinants rather than single peri-operative variables. Complications Orthopaedic complications included delayed union (30.6 %), implant failure (25 %), and infection (22.2 %). Abdominal complications comprised sepsis (33.3 %), ileus (22.2 %), and wound infection (19.4 %). Despite these morbidities, all patients survived and completed follow-up. Table 1:Baseline demographic characteristics of the study cohort showing mean age, duration of hospital stay, and time to mobilisation. Table 2: Functional outcome scores (Barthel Index and SF-36 composite) at discharge, 3 months, and 6 months postsurgery. Functional Outcome Score Mean Standard Deviation At Discharge 40.72 12.86 At 3 Months 58.86 14.71 At 6 Months 73.78 15.21 Mean Standard Deviation Age (years) 43.97 15.57 Length of Hospital Stay (days) 13.86 6.23 Time to Mobilisation (days) 9.58 3.05 Dr. Jebin Levi J, et al. Rehabilitation Outcomes Following Simultaneous Orthopaedic Fracture Fixation and Abdominal Surgery: A Prospective Observational Study. Int. J Med. Pharm. Res., 6 (6): 81‐94, 2025 85 Figure 1:Mean age, hospital stay, and time to mobilisation among patients. Table 3: Sex distribution of patients undergoing simultaneous orthopaedic and abdominal surgery. Number of Patients Percentage Sex Female 16 44.4% Male 20 55.6% Figure 2: Sex distribution of the study cohort. Table 4: Distribution of fracture sites among the study participants. Number of Patients Percentage Fracture Site Femur 7 19.4% Humerus 6 16.7% Pelvis 7 19.4% Radius/Ulna 10 27.8% Tibia 6 16.7% 40.72 58.86 73.78 0.00 10.00 20.00 30.00 40.00 50.00 60.00 70.00 80.00 At Discharge At 3 Months At 6 Months Functional Outcome Score Score Female, 44.4% Male, 55.6% Dr. Jebin Levi J, et al. Rehabilitation Outcomes Following Simultaneous Orthopaedic Fracture Fixation and Abdominal Surgery: A Prospective Observational Study. Int. J Med. Pharm. Res., 6 (6): 81‐94, 2025 86 Figure 3: Distribution of fracture sites. Table 5: Types of fracture fixation procedures performed during orthopaedic intervention. Number of Patients Percentage Type of Fracture Fixation External Fixator 10 27.8% Nailing 14 38.9% Plating 12 33.3% Figure 4: Types of fracture fixation performed. Table 6: Types of abdominal surgical procedures performed in the study population. Number of Patients Percentage Abdominal Surgery Type Appendectomy 1 2.8% Bowel Resection 2 5.6% Bowel Resection anastomosis 5 13.9% Laparotomy for hemoperitoneum 1 2.8% Laparotomy for Trauma 1 2.8% Laparotomy for Trauma hemoperitoneum 3 8.3% Loop stoma 1 2.8% Mesenteric tear repair 5 13.9% Partial Splenectomy 4 11.1% Repair of Perforation 7 19.4% Splenectomy 6 16.7% 19.4% 16.7% 19.4% 27.8% 16.7% 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% Femur Humerus Pelvis Radius/Ulna Tibia Fracture Site Percentage 27.8% 38.9% 33.3% 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0% 45.0% External Fixator Nailing Plating Type of Fracture Fixation Percentage Dr. Jebin Levi J, et al. Rehabilitation Outcomes Following Simultaneous Orthopaedic Fracture Fixation and Abdominal Surgery: A Prospective Observational Study. Int. J Med. Pharm. Res., 6 (6): 81‐94, 2025 87 Figure 5: Types of abdominal surgical procedures. Table 7: Interval between orthopaedic and abdominal surgeries among enrolled patients. Number of Patients Percentage Interval Between Surgeries (days) 0 2 5.6% 1 14 38.9% 2 20 55.6% Figure 6: Interval between orthopaedic and abdominal surgeries. Table 8: Initiation of the structured rehabilitation protocol following dual surgery. Number of Patients Percentage Rehabilitation Protocol Initiated Yes 34 94.4% No 2 5.6% 2.8% 5.6% 13.9% 2.8% 2.8% 8.3% 2.8% 13.9% 11.1% 19.4% 16.7% 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% Appendectomy Bowel Resection Bowel Resection anastomosis Laparotomy for hemoperitoneum Laparotomy for Trauma Laparotomy for Trauma hemoperitoneum Loop stoma Mesenteric tear repair Partial Splenectomy Repair of Perforation Splenectomy Abdominal Surgery Type Percentage 0, 5.6% 1, 38.9% 2, 55.6% Dr. Jebin Levi J, et al. Rehabilitation Outcomes Following Simultaneous Orthopaedic Fracture Fixation and Abdominal Surgery: A Prospective Observational Study. Int. J Med. Pharm. Res., 6 (6): 81‐94, 2025 88 Figure 7: Proportion of patients initiated on the rehabilitation protocol Table 9: Distribution of orthopaedic complications observed during follow-up Number of Patients Percentage Complications (Orthopaedic) Delayed Union 11 30.6% Implant Failure 9 25.0% Infection 8 22.2% None 8 22.2% Figure 8: Frequency of orthopaedic complications Table 10: Distribution of abdominal complications encountered post-surgery Number of Patients Percentage Complications (Abdominal) Ileus 8 22.2% Sepsis 12 33.3% Wound Infection 7 19.4% None 9 25.0% Yes, 94.4% No, 5.6% 30.6% 25.0% 22.2% 22.2% 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% Delayed Union Implant Failure Infection None Complications (Orthopaedic) Percentage Dr. Jebin Levi J, et al. Rehabilitation Outcomes Following Simultaneous Orthopaedic Fracture Fixation and Abdominal Surgery: A Prospective Observational Study. Int. J Med. Pharm. Res., 6 (6): 81‐94, 2025 89 Figure 9: Frequency of abdominal complications Table 11: Mortality rate within the six-month postoperative follow-up period. Number of Patients Percentage Mortality No 36 100.0% Table 12:Functional outcome progression with corresponding p values from repeated-measures ANOVA Functional Outcome Score Mean Standard Deviation P value At Discharge 40.72 12.86 < 0.0001 At 3 Months 58.86 14.71 At 6 Months 73.78 15.21 Table 13: Post-hoc pairwise comparison of functional outcome scores across follow-up intervals Mean Difference P value At Discharge At 3 Months -18.139 < 0.0001 At 6 Months -33.056 < 0.0001 At 3 Months At Discharge 18.139 < 0.0001 At 6 Months -14.917 < 0.0001 At 6 Months At Discharge 33.056 < 0.0001 At 3 Months 14.917 < 0.0001 Figure 10: Graphical comparison of functional outcome improvement over time. 22.2% 33.3% 19.4% 25.0% 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% Ileus Sepsis Wound Infection None Complications (Abdominal) Percentage 40.72 58.86 73.78 0.00 10.00 20.00 30.00 40.00 50.00 60.00 70.00 80.00 At Discharge At 3 Months At 6 Months Functional Outcome Score