'Damage control orthopaedics' in patients with delayed referral to a tertiary care center: experience from a place where Composite Trauma Centers do not exist

Shabir Ahmed Dhar¹ , Masood Iqbal Bhat² , Ajaz Mustafa³ , Mohammed Ramzan Mir¹ , Mohammed Farooq Butt¹ , Manzoor Ahmed Halwai¹ , Amin Tabish³ , Murtaza Asif Ali¹ and Arshiya Hamid⁴

¹Department of Orthopaedics, Government Medical College, Srinagar, Jammu and Kashmir, India

²Department of Surgery, Sheri Kashmir institute of medical sciences, Srinagar, Jammu and Kashmir, India

³Department of Hospital Administration, Sheri Kashmir institute of medical sciences, Srinagar, Jammu and Kashmir, India

⁴Department of Anaesthesia and critical care, Sheri Kashmir institute of medical sciences, Srinagar, Jammu and Kashmir, India

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Journal of Trauma Management & Outcomes 2008, 2:2doi:10.1186/1752-2897-2-2


Published:	29 January 2008

Abstract

Background

Management of orthopaedic injuries in polytrauma cases continues to challenge the orthopaedic traumatologist. Mass disasters compound this challenge further due to delayed referral. Recently there has been increasing evidence showing that damage control surgery has advantages that are absent in the early total care modality. We studied the damage control modality in the management of polytrauma cases with orthopaedic injuries who had been referred to our hospital after more than 24 hours of sustaining their injuries in an earthquake. This study was conducted on 51 cases after reviewing their records and complete management one year after the trauma.

Results

At one year, out of the 62 fractures, 3 were still under treatment, while the others had united. As per the radiological and functional scoring there were 20 excellent, 29 good, 5 fair and 5 poor results. In spite of the delayed referral there was no mortality.

Conclusion

In situations of delayed referral in areas where composite trauma centers do not exist the damage control modality provides an acceptable method of treatment in the management of polytrauma cases.