Damage control orthopedics in patients with multiple injuries is effective, time saving, and safe.

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Abstract

[Indexed for MEDLINE] 4. Eur J Trauma Emerg Surg. 2023 Aug;49(4):1933-1946. doi: 10.1007/s00068-022-02215-3. Epub 2023 Jan 20. Early total care or damage control orthopaedics for major fractures ? Results of propensity score matching for early definitive versus early temporary fixation based on data from the trauma registry of the German Trauma Society (TraumaRegister DGU(®)). von Lübken F(1), Prause S(2), Lang P(3), Friemert BD(4), Lefering R(5), Achatz G(4). Author information: (1)Department of Trauma Surgery and Orthopaedics, Reconstructive and Septic Surgery, and Sports Traumatology, German Armed Forces Hospital of Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany. FalkvonLuebken@Bundeswehr.org. (2)Department of Anaesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Therapy, German Armed Forces Hospital of Ulm, Ulm, Germany. (3)Centre for Integrated Rehabilitation, Rehabilitation Hospital of Ulm, Ulm, Germany. (4)Department of Trauma Surgery and Orthopaedics, Reconstructive and Septic Surgery, and Sports Traumatology, German Armed Forces Hospital of Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany. (5)Institute for Research in Operative Medicine, Witten/Herdecke University, Cologne, Germany. PURPOSE: Damage control orthopaedics (DCO) und early total care (ETC) are well-established strategies for managing severely injured patients. There is no definitive evidence of the superiority of DCO over ETC in polytrauma patients. We conducted this study to assess the probability of a polytraumatised patient undergoing DCO. In addition, the effect of DCO on complications and mortality was investigated. METHODS: We analysed data from 12,569 patients with severe trauma (Injury Severity Score ≥ 16) who were enrolled in the trauma registry of the German Trauma Society (TraumaRegister DGU®) from 2009 to 2016 and had undergone surgery for extremity or pelvic fractures. These patients were allocated to a DCO or an ETC group. We used the propensity score to identify factors supporting the use of DCO. For a comparison of mortality rates, the groups were stratified and matched on the propensity score. RESULTS: We identified relevant differences between DCO and ETC. DCO was considerably more often associated with packed red blood cell (pRBC) transfusions (33.9% vs. 13.4%), catecholamine therapy (14.1% vs. 6.8%), lower extremity injuries (72.4% vs. 53.5%), unstable pelvic fractures (41.0% vs. 25.9%), penetrating injuries (2.8% vs. 1.5%), and shock (20.5% vs. 10.8%) and unconsciousness (23.7% vs. 16.3%) on admission. Based on the propensity score, patients with penetrating trauma, pRBC transfusions, unstable pelvic fractures, and lower extremity injuries were more likely to undergo DCO. A benefit of DCO such as reduced complications or reduced mortality was not detected. CONCLUSION: We could identify some parameters of polytrauma patients used in the trauma registry (Traumaregister DGU®), which led more likely to a DCO therapy. The propensity score did not demonstrate the superiority of DCO over ETC in terms of outcome or complications. It did not appear to adequately adjust for the variables used here. Definitive evidence for or against the use of DCO remains unavailable. © 2023. The Author(s). DOI: 10.1007/s00068-022-02215-3 PMCID: PMC10449664