title: 'Damage control orthopaedics' in patients with delayed referral to a tertiary care center: experience from a place where Composite Trauma Centers do not exist.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Orthopaedics, Government Medical College, Srinagar, Jammu and Kashmir, India. shabirdhar@yahoo.co.in.
authors.forename: Shabir Ahmed
authors.initials: SA
authors.lastname: Dhar
authors.forename: Masood Iqbal
authors.initials: MI
authors.lastname: Bhat
authors.forename: Ajaz
authors.initials: A
authors.lastname: Mustafa
authors.forename: Mohammed Ramzan
authors.initials: MR
authors.lastname: Mir
authors.forename: Mohammed Farooq
authors.initials: MF
authors.lastname: Butt
authors.forename: Manzoor Ahmed
authors.initials: MA
authors.lastname: Halwai
authors.forename: Amin
authors.initials: A
authors.lastname: Tabish
authors.forename: Murtaza Asif
authors.initials: MA
authors.lastname: Ali
authors.forename: Arshiya
authors.initials: A
authors.lastname: Hamid