DAMAGE CONTROL ORTHOPAEDICS: A TRISS ANALYSIS OF 45 CONSECUTIVE POLYTRAUMA PATIENTS

Abstract

Background and Objectives: Damage control orthopaedics (DCO) seeks to minimize surgical impact while treating all long bone and pelvic fractures in an emergency basis. Temporary external fixation is the preferred method for DCO in polytrauma care and mass casualty events.. External fixation allows stabilisation of long bone fractures without prolonged surgical procedures; reduce blood loss and systemic inflammatory response, although it is not clear which is the effect on complications and mortality.

Materials and Methods: Case series. Retrospective analysis of data trauma registry data. We studied the clinical outcome of a consecutive group of by DCO concepts for long bone and pelvic fractures, including a mass casualty event with multiple victims from a bomb attack. We analyzed the clinical outcomes in terms of systemic complications and mortality measured by TRISS methodology.

Inclusion criteria: Age > 15, ISS> 16, external fixation in first 6 hours for long bone or pelvic fractures

Results: Between 2003 and 2008 45 patients met the inclusion criteria. Average age was 33 yrs, means ISS 35, and most patients suffered road traffic accidents. We performed 65 temporary external fixators in forty five patients. Most frequent procedures were femur external fixation in 30 cases followed by tibia external fixation in 25 patients. Systemic complication rate was high. Six patients died. We found a reduction in mortality between probability of survival by TRISS and real mortality of 0.18 (0, 67 Ps versus 0, 85 real survival)

Conclusions: External fixation for early fixation of long bone fractures in polytrauma patient is a safe and successful treatment. DCO seems to reduce mortality in severe polytrauma patients with multiple fractures.