Application of damage control orthopaedics in treatment of massive hemorrhage in severe traumatic fractures

This study is designed to investigate the clinical application value of the damage control orthopaedics (DCO) concept in guiding the treatment of severe traumatic fractures with massive hemorrhage. Using the introduction of the DCO concept in the hospital in June 2021 as the cut-off point, patients with severe traumatic fractures and major bleeding admitted in the two periods before the introduction of the DCO concept (January 2021~May 2021) and after the introduction of the DCO concept (June 2021~January 2022) were included as control group (n = 39) and observation group (n = 39), respectively. The control group was given conventional surgery and treatment, whereas the DCO group received treatment and surgery under the guidance of the DCO concept. The results of the intervention were compared between the two groups. The time from admission to definitive surgery was longer in the DCO group than that in the control group. Fewer suspended red blood cells, fresh frozen plasma and platelets were used in the DCO group compared to the control group. The total hospital stay was shorter and the rates of postoperative complications and mortality were lower in the DCO group than those in the control group. Patients were followed up for 6–8 months, with an average of (6.87 ± 1.15) months, and the results showed that the fracture healing rate in DCO group was higher than that in the control group. The concept of DCO could correctly guide the treatment of severe traumatic fractures complicated by massive hemorrhage, and improve the therapeutic safety, reduce the incidence of postoperative complications and mortality, and enhance the later fracture healing rate of patients.

Severe traumatic fractures; Massive hemorrhage; Concept of damage control orthopaedics; Therapeutic effect

[1] Kashyap A, Arora S, Khan Y, Kumar S, Chopra RK. Traumatic posterior fracture-dislocation of the fifth lumbar vertebra: report of two cases with review of literature. Spinal Cord Series and Cases. 2021; 7: 30.

[2] Segal-Isaacson CJ, Tobin JN, Weiss SM, Brondolo E, Vaughn A, Wang C, et al. Improving dietary habits in disadvantaged women with HIV/AIDS: the SMART/EST women’s project. AIDS and Behavior. 2006; 10: 659–670.

[3] Christian AB, Grigorian A, Nahmias J, Duong WQ, Lekawa M, Joe V, et al. Comparison of surgical fixation and non-operative management in patients with traumatic sternum fracture. European Journal of Trauma and Emergency Surgery. 2022; 48: 219–224.

[4] Tran A, Fernando SM, Brochard LJ, Fan E, Inaba K, Ferguson ND, et al. Prognostic factors for development of acute respiratory distress syndrome following traumatic injury: a systematic review and meta-analysis. European Respiratory Journal. 2022; 59: 2100857.

[5] Li Y, Liu Y, Chou H, Tseng H, Fu Y, Liu W. Concomitant post-traumatic ocular and cerebral fat embolism syndrome and thrombotic pulmonary embolism. Medicine. 2022; 101: e29331.

[6] Rondanelli AM, Gomez-Sierra MA, Ossa AA, Hernández RD, Torres M. Damage control in orthopaedical and traumatology. Colombia Médica. 2021; 52: e4184802.

[7] Eckhoff MD, Orr JD, Wells ME, Nesti LJ, Dunn JC. Response to letter to the editor “there is no role for damage control orthopedics within the golden hour”. Military Medicine. 2022; 187: 38–39.

[8] Oitment C, Thornley P, Jentzsch T, Pahuta M. Damage control orthopaedics in spinal trauma. Journal of the American Academy of Orthopaedic Surgeons. 2021; 29: e1291–e1302.

[9] İskender Uysal P, Şahin Kavaklı H, Neşelioğlu S. Evaluation of the thiol disulfide homeostasis in patients with traumatic hemorrhagic shock. Turkish Journal of Trauma and Emergency Surgery. 2021; 27: 516–525.

[10] Sethi M, Heidenberg J, Wall SP, Ayoung-Chee P, Slaughter D, Levine DA, et al. Bicycle helmets are highly protective against traumatic brain injury within a dense urban setting. Injury. 2015; 46: 2483–2490.

[11] Koroki T, Abe T, Kamimura S, Ochiai H. Severe traumatic brain injury in a patient with von willebrand disease type 2A successfully treated with factor VIII/von willebrand factor concentrates: a case report. American Journal of Case Reports. 2022; 23: e936690.

[12] Theodorou CM, Coleman LE, Mateev SN, Signoff JK, Salcedo ES. Successful extracorporeal life support in a pediatric trauma patient following angioembolization of pelvic hemorrhage. Journal of Pediatric Surgery Case Reports. 2021; 67: 101812.

[13] Zygogiannis K, Manolakos K, Kalampokis A, Thivaios GC, Moschos S. Traumatic fracture of the thoracic spine with severe posterolateral dislocation: a case report. Cureus. 2022; 14: e23830.

[14] Fujiwara G, Okada Y, Ishii W, Iizuka R, Murakami M, Sakakibara T, et al. Association of skull fracture with in-hospital mortality in severe traumatic brain injury patients. The American Journal of Emergency Medicine. 2021; 46: 78–83.

[15] Weber C, Andreassen JS, Behbahani M, Thorsen K, Søreide K. Characteristics, image findings and clinical outcome of moderate and severe traumatic brain injury among severely injured children: a population-based cohort study. European Journal of Trauma and Emergency Surgery. 2022; 48: 4473–4480.

[16] Lu S, Du T, Sun Z, Xu L, Tong X, Yan H. Timing of extremity fracture fixation in patients with traumatic brain injury: a meta-analysis of prognosis. World Neurosurgery. 2020; 133: 227–236.

[17] Jalles F, Janeiro M, Gonçalves M. Traumatic laryngeal fracture: a case report. Trauma Case Reports. 2021; 36: 100539.

[18] Zhou S, Zhang Q, Ding X, Qin YY, Cai S. Locking plate external fixation combined with membrane induction technology for the treatment of open and comminuted tibial fractures with bone defects. China Journal of Orthopaedics and Traumatology. 2021; 34: 400–405. (In Chinese)

[19] Altomare M, Granieri S, Cioffi SPB, Spota A, Basilicò SA, Chiara O, et al. High-Grade Limbs Open Fractures: Time to Find Milestones in the Emergency Setting. Life. 2021; 11: 1226.

[20] Coleman JR, Carmichael H, Zangara T, Dunn J, Schroeppel TJ, Campion E, et al. A stitch in time saves clots: venous thromboembolism chemoprophylaxis in traumatic brain injury. Journal of Surgical Research. 2021; 258: 289–298.

[21] Horst K, Greven J, Lüken H, Zhi Q, Pfeifer R, Simon TP, et al. Trauma severity and its impact on local inflammation in extremity injury—insights from a combined trauma model in pigs. Frontiers in Immunology. 2020; 10: 3028.

[22] Gaasch S. Critical care considerations for damage control in a trauma patient. AACN Advanced Critical Care. 2021; 32: 64–75.

[23] Yu LQ, Meng CC, Jin XS, Cai J. Clinical study of sodium bicarbonated Ringer’s solution on fluid resuscitation of patients with hemorrhagic shock. European Review for Medical and Pharmacological Sciences. 2022; 26: 1535–1542.

[24] Ribeiro-Junior MAF, Costa CTK, de Souza Augusto S, Néder PR, Elia YGB, Rattan R, et al. The role of direct peritoneal resuscitation in the treatment of hemorrhagic shock after trauma and in emergency acute care surgery: a systematic review. European Journal of Trauma and Emergency Surgery. 2022; 48: 791–797.

[25] Meléndez-Lugo J, Caicedo Y, Guzmán-Rodríguez M, Serna JJ, Ordoñez J, Angamarca E, et al. Prehospital damage control: the management of volume, temperature ... and bleeding! Colombia Medica. 2020; 51: e4024486.

[26] Ethiraj P, Shringeri AS, Prasad P A, Shanthappa AH, Nagarajan V. Early total care versus damage control orthopedics in floating knee injury: analysis of radiological and functional outcomes. Cureus. 2022; 14: e25615.

[27] Giral G, Grosset A, Podeur P, Bélot-de Saint Leger F. Successful deployment of the french damage control resuscitation and surgical team in 2021: lessons learned from its first massive casualty event. Military Medicine. 2022; 187: 40–41.

[28] Li F, Gao L, Zuo J, Liu G. Promotion of a damage control concept in repairing orthopedic lower limb trauma. American Journal of Translational Research. 2022; 14: 3278–3285.

[29] Fan H, Fei R, Guo C, Li Y, Yan C, Chen F, et al. Effects of emergency treatment mode of damage-control orthopedics in pelvic fracture complicated with multiple fractures. American Journal of Translational Research. 2021; 13: 6817–6826.

[30] Sanchez-Tamayo M, Sanchez-Martin ML, Garcia-Real E, Garcés-Tamayo MC. Essential aspects during the resuscitation of intravascular volume in polytraumatized patients. Medwave. 2020; 20: e7879. (In Spanish)