Practical Application of Concept "Damage Control" in Treatment of Long Bone Extremity Fractures in Patients with Polytrauma

On the base of experience in treatment of 646 patients with polytrauma (1995—2004) the necessity to use damage control was for the treatment of long bone fractures was proved. The principle of damage control assumes subdivision of surgical treatment of patients with severe polytrauma into two steps. At the I st step only minimum traumatic procedures were performed. At the 2 nd step major surgical interventions were performed. According to trauma severity and individual response all patients were divided into four groups: stable, borderline, unstable and critical. In patients with stable and borderline conditions major surgical procedures did not result in aggravation of patient's state, therefore one-step surgical treatment was used. In patients with unstable and critical conditions no surgical methods of fixation of long bone fractures were applied at the I st step. In the last two groups definitive fracture fixation were performed at the 2' d step within 4—14 days after injury. The application of damage control allows improving the results of treatment, reducing the rate of complication and lethal outcomes in patients with severe polytrauma.