Changes in the management of femoral shaft fractures in polytrauma patients: from early total care to damage control orthopedic surgery.

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Abstract

[Indexed for MEDLINE] 17. Eur J Trauma Emerg Surg. 2019 Oct;45(5):801-808. doi: 10.1007/s00068-019-01092-7. Epub 2019 Feb 13. Surgical treatment strategies in pediatric trauma patients: ETC vs. DCO-an analysis of 316 pediatric trauma patients from the TraumaRegister DGU(®). Horst K(1), Andruszkow H(2), Weber CD(2), Pishnamaz M(2), Knobe M(2), Bläsius FM(2), Lichte P(2), Lefering R(3), Hildebrand F(2). Author information: (1)Department of Trauma and Reconstructive Surgery, RWTH Aachen University, Pauwelsstreet 30, 52074, Aachen, Germany. khorst@ukaachen.de. (2)Department of Trauma and Reconstructive Surgery, RWTH Aachen University, Pauwelsstreet 30, 52074, Aachen, Germany. (3)IFOM, Institute for Research in Operative Medicine, Faculty of Health, University Witten/Herdecke, Ostmerheimer Straße 200, 51109, Cologne, Germany. PURPOSE: External fixation within the damage control concept in unstable multiple trauma patients is widely accepted. Literature about its usage in the pediatric trauma population, however, is rare. The aim of the present study was to elucidate the factors associated with the application of external fixation in the severely injured child. METHODS: Patients with severe trauma aged 0-54 years documented in the TraumaRegister DGU® were included in this study. Demographic data, pattern of injury, injury severity, use of the damage control orthopedics (DCO) or early total care (ETC) concept, duration of mechanical ventilation, intensive care stay, and total hospital stay as well as the occurrence of complications and mortality were evaluated. Statistical evaluation was performed using SPSS (Version 21.0.0) using Chi square tests and linear regression models. RESULTS: While injury severity was comparable between children and adults, type of accident and injury patterns showed significant differences, Overall, the majority of surgical fracture stabilization in AISExtremity ≥ 3 injuries followed the DCO concept in adults (60.3%) and the ETC protocol in children (49.4%). Conservative treatment was chosen for only 11.6% of all children and 9.6% of all adults. An increasing injury severity, AISExtremity ≥ 3 and AISExtremity ≥ 3 in ≥ 2 body regions, and a more advanced age were found to be independent factors in the use of the DCO concept in children. CONCLUSION: Use of external fixation increases with age and plays a minor role in the very young trauma population. However, this does not produce a difference in outcome between children and adults. DOI: 10.1007/s00068-019-01092-7