Application of damage control technique in treatment of intertrochanteric fracture in the elderly

Abstract

Objective To evaluate the clinical efficacy of damage control measures in treatment of femoral intertrochanteric fracture among the elderly.Methods A total of 166 patients with intertrochanteric fracture treated with damage control measures from December 2008 to December 2013 were included in the retrospective study.There were 68 men and 98 women at age of (85.23 ±3.19) years.Fracture classification using the AO system was type A1 in 18 cases,type A2 in 89 cases and type A3 in 59 cases.Mortality and incidences of postoperative complications were predicted respectively by the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) and Portsmouth modified POSSUM (P-POSSUM).The validity of damage control measures was evaluated by comparing the predicted risks and observed outcomes.Results On admission,there were 61 patients with low risk of complications (POSSUM ＜ 20 points) treated with damage control surgery but 105 patients with high risk of complication (POSSUM ≥20 points) treated with physiological control following damage control surgery.Predicted incidences of complications and mortality were (48.6 ± 6.8) ％ and (10.1 ±1.9) ％ respectively prior to damage control,but they were (35.6 ± 4.5) ％ and (4.6 ± 1.4) ％ after damage control.Observed incidences of complications and mortality were 37.4％ and 1.8％ respectively,with significant differences in comparison with those before damage control (all P ＜ 0.05).Conclusion For the elderly patients with intertrochanteric fracture,damage control measures can avoid surgical risks and reduce the incidences of postoperative complications and death. Key words: Femoral fractures; Aged; Damage control orthopedics