DAMAGE CONTROL SURGERY FOR FEMORAL FRACTURES IN POLYTRAUMA PATIENTS
Abstract:
Treating femoral fractures in polytrauma patients remains challenging, as avoiding the
“second hit” phenomenon which might be induced by femoral stabilization means choosing the proper
moment and method for it. Everybody agrees that early fixing in polytrauma patients is of significant
benefit, but debates still persist about the method of performing it. This has changed during the last
years, from primary nailing, called Early Total Care (ETC) to a sequential method called Damage
Control Orthopaedic Surgery (DCOS) - initially less risking external fixation, followed by
intramedullary nailing after patient’s stabilization, especially in polytrauma patients at risk of organ
failure. The benefit/risk ratio of each method can be evaluated by the incidence of local and systemic
complications, especially multiple organ failure and death.
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