title: Damage control orthopaedics in severe polytrauma with femur fracture.
abstract: OBJECTIVE
  To evaluate the rate of systemic complications and mortality in severe polytrauma patients with associated femur fracture treated by early external fixation of femur.
  
  
  METHODS
  We made a retrospective cohort study with forty-one adult multitrauma patients (New Injury Severity Score ≥ 19) with femur fracture treated by external fixation following Damage Control Orthopaedic surgery. The mortality rates, TRISS analysis, incidence of ARDS and MOF were analysed.
  
  
  RESULTS
  The mean NISS was 41.2 and the mean age 32.7. 50% of patients were in shock on admission. All patients were treated in the first 12 hours with external fixation. 30% of patients developed ARDS and six patients had MOF. Five patients treated by external fixation died. Difference between predicted mortality by TRISS and actual mortality showed a reduction of 15.9% (0.71 predicted survival versus 0.88 real survival).
  
  
  CONCLUSIONS
  An aggressive and early Damage Control approach to treat femur fractures in severe polytrauma patients led to low mortality rate comparing to the predicted mortality by TRISS.
authors.affiliation: Orthopaedic Surgery Department, Hospital 12 de Octubre, Madrid, Spain. pedrocabado@gmail.com
authors.forename: Pedro
authors.initials: P
authors.lastname: Caba-Doussoux
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Leon-Baltasar
authors.forename: Carlos
authors.initials: C
authors.lastname: Garcia-Fuentes
authors.forename: Carlos
authors.initials: C
authors.lastname: Resines-Erasun
mesh_terms: D000328:Adult; D003422:Critical Care; D004638:Emergency Treatment; D016267:External Fixators; D005260:Female; D005264:Femoral Fractures / Q000401:mortality* / Q000601:surgery; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D009104:Multiple Trauma / Q000401:mortality* / Q000601:surgery; D012128:Respiratory Distress Syndrome / Q000401:mortality*; D012189:Retrospective Studies; D012771:Shock, Hemorrhagic / Q000401:mortality*; D013997:Time Factors; D015599:Trauma Severity Indices; D016896:Treatment Outcome