[Retrospective study on staged treatment of long bone shaft fractures with severe thoracic trauma]

To evaluate the feasibility and efficacy of staged treatment of patients with long bone shaft fractures and severe thoracic trauma.

A retrospective study was performed on 41 patients with long bone shaft fractures and severe thoracic trauma who underwent staged treatment under the guidance of damage control orthopedics from January 2005 to October 2009 in our department. Among the patients,29 patients were male and 12 patients were female,with an average age of (37.2 +/- 6.1 ) years (ranged, 17 to 65 years). On admission, the value of injury severity score (ISS) for these patients was above 16 and the average value was 27.4. The therapy process included three stages: first stage,controlling thoracic symptoms and provisionally fixing fracture; second stage, resuscitating and optimizing physiological condition in intensive care unit;third stage, operating for fractures when pathogenic condition was equable.

There was no dead case. Pathogenic condition of thorax in all patients regained equable in 5 d to 23 d and long bone shaft fractures were fixed in 10 d to 25 d after injury. There was no seriously operative or postoperative complication. All the patients were followed up, the duration ranged from 6 to 36 months, with an average of 19.4 months. Their respiratory functions were good. The long bone shaft fractures were healed in 10 to 16 weeks among 38 patients. The bone nonunion happened in 1 patient with closed fracture and 2 patients with opened fracture.

Damage control orthopedics is a safe strategy for treatment of long bone shaft fractures with severe thoracic trauma. It is suggested that the surgeons should take a staged approach to perform damage control and definitive surgery.