A PROSPECTIVE COMPARATIVE STUDY OF EARLY TOTAL CARE VS DAMAGE CONTROL ORTHOPEDICS IN POLY-TRAUMATIZED PATIENTS

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Abstract

Aim: To compare the efficacy and treatment outcomes of early total care (ETC) and Damage control orthopedics in management of poly traumatic patients A total of 64 admitted poly-traumatized patients were Materials and methods: studied in between February 2022 to June 2023. The patients presented with femoral and /or tibial shaft fractures and associated multiple injuries. The treatment was done in a tertiary care medical hospital. The patients were divided into two groups based on the treatment strategies. Group A patients were treated by early total care (ETC) and intramedullary nailing (IMN) within 24 hours of injury. Group B patients were treated with temporary external fixation as a bridge to IMN. There were 34 patients in group A and 30 patients in group B. The outcomes of the treatments were analyzed retrospectively. Institutional ethical committee approval was obtained and written informed consent was taken from all the patients. A p value <0.005 was considered to have a statistical significance The groups were compar Results: able with respect to age, gender, mechanism of injury and ISS. The patients in the DCO group required more fluids when compared to the ETC group (6.2 vs 2.2 PRBC). The estimated blood loss was more in ETC group when compared to the DCO group (400 cc vs 90 cc) Mean operative time was 45 minutes for external fixation and 100 minutes for IMN. There was a significantly increased incidence of MOF (20.5% vs 6.6%) and ARDS (17.6% vs 6.6%) in DCO group when compared to ETC group. ETC group was associated with increased incidence of wound infection, osteomyelitis Conclusion: External fixation is a safe procedure for achieving rapid, temporary rigid stabilization in unstable patients with multiple injuries. This procedure is associated with less blood loss and minimum systemic complications like ARDS and MOF, when compared to Early treatment group (ETC)