Efficiency of the Damage Control Orthopedic Strategy in the Management of Military Ballistic Limb Trauma.

Abstract Background: In conflicting areas, orthopaedic surgeons adopted this concept of damage control orthopaedic (DCO) to face limb fracture due to ballistic trauma because of the gravity of the hurts, the limitation of equipment, and precarious conditions of asepsis. They use external fixation as an initial treatment at the nearest health centre. They delay the definitive treatment to be realized in better conditions. Our study aims to assess the outcome of the damage control orthopaedic (DCO) strategy in military ballistic limb trauma according to the experience of the Military Hospital of Tunisia.Materials and methods: This study is a retrospective study on patients who were hospitalized for a limb ballistic fracture. It includes military patients treated urgently with primary external fixation at the nearest health centre. We adapted the Gustilo classification to describe wound opening, the Winquist and Hansen classification to define fracture comminution and the grading system for bone loss to evaluate bone loss. Then, all victims were evacuated secondary to the military hospital to receive the definitive treatments. The conversion to internal osteosynthesis had taken place according to some criteria. They were the absence of local sepsis, a haemoglobin level (> 10 g/dl), a serum protein level (> 50 g/l) and negative or falling CRP kinetics. We studied the delay of conversion from external fixation to internal osteosynthesis, bone healing time and complications.Result: Our study included 32 patients, all men, with a mean age of 31 years. The average follow-up was 33.2 months. Eighty-eight percent of trauma concerned the lower limb. The average delay for conversion from external fixation to internal osteosynthesis was 7.8 days. Bone union was achieved in 26 cases, with an average delay of 4.23 months. The observed general complications were anaemia, pulmonary embolism and rhabdomyolysis. Local complications were essentially sepsis on osteosynthesis material and pseudarthrosis. These complications were significantly associated with a type III Gustilo skin opening, a type III and IV Winquist fracture comminution, a type II and III Grading system for bone loss, and a delay in conversion from external fixation to internal osteosynthesis.Conclusion: DCO is a global strategy that involves all measures participating in the acceleration of wound healing and fighting against infection. These measures shorten the delay of conversion from external fixation into internal osteosynthesis, which constitutes a key parameter in the management of limb fracture due to ballistic trauma.