Application of damage control orthopaedics to treating Gustilo type Ⅲ tibial and fibulal fracture
LIN Wenxiang 1, WANG Zhiqiang 2, FAN Ximing 1, SUN Minghua 2，and WANG Yanpeng 2.
1. Department of Orthopaedics, Hospital of Corps 8650, Chinese People’s Armed Police Forces, Jinzhong 030600, China;
2. Department of Orthopaedics, Affiliated Hospital of Logistics College of Chinese People’s Armed Police Forces, Tianjin 300162, China
Abstract：Objective To discuss and analyze the clinical effect of damage control orthopaedics (DCO) in 56 patients with Gustilo type III fractures of tibia and fibula. Methods A retrospective analysis was made of the 56 patients who were admitted from January 2006 to December 2010 for Gustilo type Ⅲ fractures of tibia and fibula. There were 19 cases of type ⅢA, 32 cases of type ⅢB, and 5 cases of ⅢC. All the 56 cases were treated with anti-shock measures, followed by vacuum sealing drainage and external fixation of fractures thorough debridement in the first stage, resuscitation in the ICU in the second stage, and definite surgery if the parenchyma permitted in the third stage. Results All the 56 patients were followed up for 16.8 months on average (12-27 months). There were 3 cases (5.4%) of delayed healing and 53 cases (94.6%) of bone healing by first intention. No osteomyelitis, bone nonunion or further complications were observed. The scoring system Johner-Wruhs assessment of efficacy for treatment was used. The results were excellent in 26 cases, good in 24 cases, and poor in 6 cases. The excellent and good rate was 89.3%. Conclusions Application of DCO is effective for Gustilo type Ⅲ fractures of tibia and fibula with haemorrhagic shock and/or no craniocerebral injury, chest injury and abdomen injury. In the early treatment of such fracture, external fixation for fracture repair, thorough debridement and VSD covering wound surfaces should be emphasized.
