The clinical application of damage control orthopaedics strategy in treatment of multiple traumas combing with bone injuries.

Abstract

Objective To evaluate the feasibility and safety of the damage control orthopedics (DCO) strategy in the treatment of multiple traumas combine with bone injuries. Methods Forty-seven se-vere multiple injuries patients were treated by DCO strategy in our center. There were 35 males, 12 females, with a mean age of 32.8 years (17-55 years). There were 28 for open fractures, and 19 for close fractures. Other system injuries mainly include: brain injury 15 cases, breast injury 20 cases, abdominal injury 17 cases. Mean injury severity score was 33.4, mean glasgow coma score was 11.4, mean systemic inflammatory response syndrome score was 2.9. After the early resuscitation and one-stage of damage control surgery, all patients were send to ICU for a profound resuscitation. Two -stage definitive osteosynthesis were executed when the patients were stabilization. The data of time spend, blood loss, and complications of operations were recorded to evaluation. Results In the one-stage procedure, the mean time spend on bone injury for each patients was 65 min, blood loss during the operation was 185 ml. The two-stage definitive osteosynthesis were performed average 7 days after the one-stage procedure, and the time spend and blood loss during the oper-ation were (142±29) min and (420±70) ml, respectively. Three patients died from the deteriorate after one-stage procedure. Six cases development complications after the operation. Fat embolism, deep vein thrombus and others deteriorate associate with the one-stage procedure were not found. Four patients were all obtained neurologic improvement who has spinal fractures combined with spinal cord injuries. 39 cases were followed up for a mean time of 9 months (range, 3-14 months). No long-term complications were found, and the frac-tures got a satisfactory healing. Conclusion DCO appears to reduce the extent of second-hit, control the in-crease of systematic inflammatory response, deduce the risk of the operation for those severe multiple trauma patients, and have a satisfactory clinical outcome, is a safe, effective, feasible treatment strategy. Key words: Multiple trauma; Fractures; Surgical procedures, operative