Damage control orthopaedics (Scalea)

External fixation as a bridge to intramedullary nailing for patients with multiple injuries and with femur fractures: damage control orthopedics.

Scalea TM, Boswell SA, Scott JD, et al. The Journal of trauma 2000 · PMID 10780592 · doi:10.1097/00005373-200004000-00006

Question

Is initial external fixation followed by delayed intramedullary nailing a safe strategy for femoral fractures in severely injured patients?

Design

Retrospective cohort study from a single US level I trauma centre.

Patients

Multiply injured patients with femoral shaft fractures.

Intervention

Temporary external fixation with later conversion to intramedullary nailing

Comparison

Early primary intramedullary nailing (early total care)

Primary outcome

Mortality and complications

Key result

Patients managed with external fixation were more severely injured, yet the staged approach was safe with low conversion complication rates, supporting its use in unstable patients.

Limitations

Non-randomised retrospective design with selection bias, as sicker patients were chosen for external fixation.

Impact on practice

Helped establish damage control orthopaedics in the physiologically unstable or borderline polytrauma patient, while early total care remains appropriate for stable patients.