Damage control orthopaedics in severe polytrauma with femur fracture

OBJECTIVE:To evaluate the rate of systemic complications and mortality in severe polytrauma patients with associated femur fracture treated by early external fixation of femur. PATIENTS AND METHODOLOGY:We made a retrospective cohort study with forty-one adult multitrauma patients (New Injury Severity Score ≥ 19) with femur fracture treated by external fixation following Damage Control Orthopaedic surgery. The mortality rates, TRISS analysis, incidence of ARDS and MOF were analysed. RESULTS:The mean NISS was 41.2 and the mean age 32.7. 50% of patients were in shock on admission. All patients were treated in the first 12 hours with external fixation. 30% of patients developed ARDS and six patients had MOF. Five patients treated by external fixation died. Difference between predicted mortality by TRISS and actual mortality showed a reduction of 15.9% (0.71 predicted survival versus 0.88 real survival). CONCLUSIONS:An aggressive and early Damage Control approach to treat femur fractures in severe polytrauma patients led to low mortality rate comparing to the predicted mortality by TRISS.