Damage control orthopaedics in severe polytrauma with femur fracture.

Abstract

To evaluate the rate of systemic complications and mortality in severe polytrauma patients with associated femur fracture treated by early external fixation of femur. 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. 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). 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.