The management of multiple injury arevery complex situation. For treatment of lower extremity, especially withfracture femur in patients with multiple injuries. The controversy of evidencesabout the optimal time to fixation divided commonly in two strategies, earlydefinite fixation and damage control orthopedics ( DCO). Early definitive fixation has perform within 24hours after injury.
The benefit of Earlydefinitive fixation has shown lower of pulmonary complications, short length of stay anddecrease morbidity.(1-4) But some evidencessuggest that early fixation of long bone can produces more complication inpatients with head injury and chest injury(5-7) and can increase the inflammatory process,hypoperfusion and ” second hit injury”.(8-10). For DCO, whichmethod can use for patients with multiple injuries and unstable conditions andfollowed by definite fixation later.
(11-14) DCO has shown theadvantage of early fixation foe example pulmonary function and relief pain.(14) And DCO can preventthe complication from early definite fixation such as inflammatory condition may be leading to acute respiratorydistress syndrome(ARDS),acute renal failure(ARF) and multiple organ failure(MOF).(15,16) Many evidences havebeen support the benefit of DCO but contrary to the meta-analysis has shownprotective effect of early definite fixation from pulmonary complicationscompare with DCO ( RR 0.
30,0.22-0.40 90% CI).(17) But some data report no difference inmorbidity and mortality between earlyand late definite fixation of long bone.(18)For the inconclusive about the evidencewhich support the benefit of DCO compare with early definite fixation and theoptimal time to definite fixation of long bone for prevent any complications. Theaim of this study to determine the complication and effect of timing offixation and investigates risk factors for complications in multiple injuriespatients with lower extremity fracture.
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