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A Saline/Bipolar Radiofrequency Energy Device As an Adjunct for Hemostasis in Solid Organ Injury/Trauma

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Damage control surgery - experiences from a level I trauma center.

Bernhard Gasser¹, Thomas M Tiefenboeck², Sandra Boesmueller¹

¹Department of Trauma Surgery, Medical University of Vienna, Waehringerguertel 18-20, A-1090, Vienna, Austria.

BMC Musculoskeletal Disorders

|September 13, 2017

Summary

Treatment choices for long bone fractures in multi-system trauma patients, including damage control orthopaedics (DCO), early total care (ETC), and external fixation (EF), depend on injury severity and fracture characteristics. High injury severity scores and open fractures often lead to DCO or EF, with EF having higher complication rates.

Keywords:

Damage control surgery External fixation Intramedullary nailing Outcome Retrospective study

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Area of Science:

Orthopaedic surgery
Trauma care
Biomechanics

Background:

Limited evidence exists for damage control orthopaedics (DCO), early total care (ETC), or sole external fixation (EF) in multi-system trauma patients with long bone fractures.
Understanding treatment selection factors is crucial for optimizing outcomes in complex trauma cases.

Purpose of the Study:

To identify parameters influencing the clinical choice between DCO, ETC, and EF for femoral or tibial shaft fractures in patients with multi-system trauma, severe soft tissue damage, or both.

Main Methods:

Analysis of clinical data from 236 patients with 280 lower extremity long bone fractures treated at a Level I trauma center.
Evaluation of patient parameters on arrival, including age, sex, Injury Severity Score (ISS), fracture site, soft tissue damage (Gustilo-Anderson classification), and pulmonary injury, to determine their influence on treatment selection (DCO/ETC/EF).

Main Results:

High ISS and severe soft tissue damage (grade III) significantly correlated with DCO. High ISS, older age, female sex, and tibial fractures correlated with EF.
The group treated solely with EF exhibited the highest complication rate, with 69% experiencing at least one complication.

Conclusions:

Severely injured patients are more frequently treated with DCO or EF.
Higher ISS (≥16) and type III open fractures increased DCO utilization.
ISS, fracture site, patient age, type III open fractures, and female sex increased EF use compared to ETC.