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Clinic for Orthopaedic Surgery and Traumatology
Clinical Center Niš
Bul. dr Zorana Đinđića 48
18000 Niš, Serbia
”DAMAGE CONTROL“ STRATEGY IN THE TREATMENT OF POLYTRAUMA PATIENTS WITH OPEN FEMORAL SHAFT FRACTURE COMBINED WITH SPLENIC RUPTURE - A CASE REPORT
Ivan Golubović1, Predrag Stojiljković1, Zoran Golubović1, Goran Stevanović2, Ivan Micić1,
Zorica Antić2, Aleksandar Višnjić2 , Stevo Najman2, Dragan Milić2, Milan Grubor3 ,
Sonja Stamenić1, Danilo Stoiljković2 and Miroslav Trojanović4
Clinic for Orthopaedic Surgery and Traumatology, Clinical Center Niš, Serbia1
University of Niš, Fakulty of Medicine, Niš, Serbia2
Clinic for Orthopaedic Surgery and Traumatology Banja Luka, Republika Srpska3
University of Niš, Faculty of Mechanical Engineering, Niš, Serbia4
Polytrauma represents the most difficult form of trauma epidemic. Appropriate treatment of the femoral shaft fracture in polytrauma patients can significantly reduce mortality and morbidity. External skeletal fixation in patients with femoral shaft fracture presents a minor surgical trauma with minimal blood loss. In modern trauma centres, external skeletal fixation in polytrauma patients is a temporary method (as a part of „damage control“strategy) where immediate extensive internal fixation could be risky. It is usually postponed until the patient status is stable with normal vital parameters.
This paper presents a polytrauma patient with dominant abdominal injury and femoral shaft fracture. During the same operation, external skeletal fixation was applied after abdominal surgery was done. Conversion of external into internal fixation was carried out because of postoperative febrile state that lasted for 14 days. External skeletal fixation was a definitive method of treatment. Fracture of the femoral shaft healed after 7 months with good functional outcome.
External skeletal fixation is a successful method of treatment for femoral shaft fracture in polytrauma patients. It is a temporary method as a part of „damage control“ strategy and is usually followed by internal fixation. Sometimes, it is a definitive treatment method in patients with open and comminuted fractures of the femoral shaft and in polytrauma patients when the above mentioned conversion is not safe. Acta Medica Medianae 2011;50(3):58-62.
Key words: polytrauma, femoral shaft fracture, external fixation, damage control