Application Of Damage Control Orthopedics For Treatment Of Severe Multi-injured Patients With Fractures

Objectives The severe multiple injuries are usually caused by high energy injury,often accompanied by severe fracture.There have been many controversies about the treatment of multiple injuries with fracture,including damage control orthopedics(DCO)concept for the treatment of this kind of patients.This research explores the effect of injury control orthopedic technique in the treatment of severe multiple injuries and fractures.Methods Using retrospective analysis methods,we analyzed 27 patients with severe multiple injuries and fractures who were treated with the DCO concept from January 2014 to December 2016,including 18 male and 9 female,aged 28 to 60 years,with an average of(41.57±8.29)years old,ISS score 16 to 28,with an average of(22.56±4.06)and 30 patients of severe multiple injuries and fractures were treated with early deterministic treatment from January 2007 to December 2009,including 16 males and 14 females,aged 19 to 55 years with average age of(38.33±9.99)years,had the ISS score of 18 to 33 with an average score of(24.85±4.71).All the patients came from the Department of Orthopedic Surgery,Affiliated Department of Orthopedics Hospital and Affiliated Hospital of North China University of Science and Technology.The clinical data of the two groups were compared and analyzed.The total operation time,ICU resuscitation time,blood transfusion,length of hospital stay,mortality,and complications were compared between the two groups.Results In patients treated with damage control orthopedics,26 patients survived and 1 patient died because of multiple organ failure.Postoperative complications occurred in 4 cases(acute respiratory distress syndrome in 1 case,nail infection in 2 cases,multiple organ failure in 1 case).In patients treated with early deterministic treatment,22 patients survived and 8 died,of which 2 died after multiple organ failure(MOF),3 died of hemorrhagic shock and 3 died of DIC.Postoperative complications occurred in 10 cases(acute respiratory distress syndrome in 4 cases and nail infection in 3 cases after operation.Postoperative wound infection occurred in 2 patients,multiple organ failure occurred in 2 patients and 3 patients with diffuse intravascular coagulation.The intraoperative blood transfusion volume,ICU recovery time and mortality were significantly different from those in ETC group(P<0.05).There was no significant difference in total operation time,hospital stay and complications between the two groups(P>0.05).Conclusions For the patients with severe multiple injuries and fractures,the concept of damage control orthopedics can significantly decrease the mortality rate,reduce the recovery time of ICU,decrease the amount of blood transfusion during operation.