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Promotion of a damage control concept in repairing orthopedic lower limb trauma.

OBJECTIVE
To explore the application value of the concept of damage control orthopaedics (DCO) in clinical treatment of lower limb fractures.


METHODS
In this retrospective analysis, 157 patients with lower extremity fracture, who received surgery in Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine (Cangzhou Orthopaedic Hospital) during March 2019 and August 2020, were chosen as research subjects. Among them, 73 patients admitted from March to December 2019 were included in the control group, and the other 84 patients admitted from January to August 2020 were included in the observation group. The control group received conventional fracture treatment scheme, and the observation group was treated under the DCO concept. The operation time, postoperative hospital stay, fracture reduction quality, incidence of complications, and bone metabolism and bone healing pre- and post-treatment were compared between the groups.


RESULTS
The operation time, time to achieve stable vital signs and hospital stay of the observation group were apparently shorter than those of the control group (P<0.05). Visual analog score (VAS) of patients in both groups on postoperative day 3 and 7 were substantially lower than those on postoperative day 1 (P<0.05), and VAS scores of patients in the observation group were markedly lower than those in the control group (P<0.05). Serum Interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in the two groups were significantly reduced on 14th day after surgery compared to those before surgery (P<0.05), and the indexes of observation group were lower than those of control group (P<0.05). Serum Osteocalcin (BGP), carboxyterminal of type I procollagen (PICP), alkaline phosphatase (ALP), Soluble intercellular adhesion molecule-1 (sICAM-1) and Insulin like growth factor-1 (IGF-1) in the two groups postoperative day 14 were obviously higher than those before operation (P<0.05), and the indicators in the observation group were higher than those of the control group (P<0.05). The incidence of complications in the control group was significantly higher than that in the observation group (P<0.05).


CONCLUSION
The application of the DCO concept in the clinical treatment of lower extremity trauma can effectively promote the rehabilitation of patients with lower extremity trauma, minimize their complications, improve the bone metabolism and bone healing degree, and reduce the degree of pain.