Avraham Dana, Herman Amir, Oulianski Maria
Orthopedic Department, Kaplan Medical Center, Israel.
Trauma Case Rep. 2024 May 17;52:101037. doi: 10.1016/j.tcr.2024.101037. eCollection 2024 Aug.
Multi-trauma patients require a multidisciplinary team, especially in the presence of various body systems injuries. The evaluation focuses on the decision regarding the DCO and ETC approaches.
A 24-year-old male patient with Glasgow Coma Score 8, arrived at the emergency room, followed by ATLS protocol. Orthopedic trauma included D8 vertebra unstable burst fracture, right open femur shaft fracture, left closed midshaft femur fracture, and right tibial plateau fracture of the knee.
A hemodynamically stable patient with bilateral femur fractures is directed toward the DCO approach.
An initial treatment for an external fixator across the knee on the right leg and a spine fusion and decompression of D5-10 surgery was made on the day of admission. Definitive fixation and conversion to internal fixators were done on day 9 after the accident. Postoperative drop-foot injury was seen in the right leg. A Masquelet technique was applied for the right femur segmental fracture due to gaps.
DCO may be employed to temporarily stabilize fractures, allowing the patient to recover from other life-threatening injuries before definitive fixation. Further secondary procedures, such as the Masquelet technique, should be considered to optimize the results. Long-term follow-up and rehabilitation are part of recovery, aiming to optimize functional recovery and improve the patient's quality of life.
多发伤患者需要多学科团队，尤其是在存在多种身体系统损伤的情况下。评估重点在于关于损伤控制手术（DCO）和早期全面处理（ETC）方法的决策。
一名格拉斯哥昏迷评分8分的24岁男性患者抵达急诊室，遵循高级创伤生命支持（ATLS）方案。骨科创伤包括第8胸椎不稳定爆裂骨折、右股骨干开放性骨折、左股骨干中段闭合性骨折以及右胫骨平台骨折。
一名血流动力学稳定的双侧股骨骨折患者采用损伤控制手术方法。
入院当天对右腿进行了跨膝关节外固定器的初始治疗，并对D5 - 10节段进行了脊柱融合和减压手术。事故发生后第9天进行了确定性固定并转换为内固定器。术后右腿出现垂足损伤。由于存在间隙，对右股骨节段性骨折应用了Masquelet技术。
损伤控制手术可用于暂时稳定骨折，使患者在确定性固定之前从其他危及生命的损伤中恢复。应考虑进一步的二次手术，如Masquelet技术，以优化治疗效果。长期随访和康复是恢复过程的一部分，旨在优化功能恢复并提高患者生活质量。
