Femoral shaft fractures with polytrauma best managed with ‘damage control orthopaedics’
BERLIN — The latest approach to femoral shaft fractures combined with polytrauma to emerge is not a treatment as much as it is damage control surgery, which starts the moment after the surgeon makes an initial decision about the patient’s physiology.
According to Ingo Marzi, MD, who addressed this strategy during a symposium organized by the European Society for Trauma and Emergency Surgery, here, “Damage control means you stabilize the patient and save the femur until when the patient is in a better situation.”
He said “damage control orthopaedics” is done best by assessing which polytrauma patients are at the greatest risk of experiencing the most severe complications and temporarily stabilizing the fracture, usually with an external fixator.
In his presentation during the society’s special session at 13th EFORT Congress 2012, Marzi, of Frankfurt, Germany, discussed the parameters to which a damage control surgeon might refer.
He described at risk patients as those with injury severity scores (ISS) greater than 40 points, hypothermia or with an ISS greater than 20 points in combination with a chest Abbreviated Injury Scale score greater than 2 points, among other factors.
Polytrauma patients with femoral shaft fractures that are most at-risk should have their definitive surgical procedure, such as nailing, delayed until after initial stabilization is achieved. He said that could be as early as 5 days after applying external fixation or as late as 3 weeks later.
Waiting to nail the fracture also reduces the chances that the nailing procedure will stimulate unwanted inflammation, Marzi said.
He said the patients with femoral shaft fracture who are eligible for early total care in this setting are individuals with an ISS less than 17 points and possibly as high as 25 points. Young age also dictates when early total care may be beneficial. However, in someone with psychological derangement, “you must do damage control orthopaedics,” Marzi said.
- Marzi I. Treatment of the femur fracture in polytrauma patients. Specialty session presented at the 13th EFORT Congress 2012. May 23-25. Berlin.