Highlights
- •In DCO, Ex-fix stabilization is normally followed by a conversion to internal fixation, the optimum timing and method of which are still debated.
- •We wanted to determine whether the timing and the method of conversion one-stage influence the development of infection and non-union.
- •We analysed a series of 94 lower limb closed fractures who underwent DCO then converted to plate or nail, comparing them by timing of conversion.
- •The comparison did not show a significant correlation between timing of conversion within 22 days from DCO and infection or non-union.
- •These findings tell us that lower limb closed fractures can be safely converted to definitive fixation within 22 days from DCO in 1-stage procedure.
Abstract
Introduction
In damage control orthopaedics (DCO), fractures are initially stabilised with external
fixation followed by delayed conversion to definitive internal fixation. The aim of
this study is to determine whether the timing of the conversion influences the development
of deep infection and fracture healing in a cohort of patients treated by DCO after
a closed fracture of the lower limb. Furthermore, we wanted to evaluate whether the
one-stage conversion procedure is always safe.
Materials and methods
A retrospective cohort study was conducted at a single level 1 trauma centre. Ninety-four
cases of closed fractures of lower limb treated by DCO subsequently converted to internal
fixation from 2012 to 2019 were included. Development of deep infection, superficial
infection, non-union and time to union were recorded. Patients were then divided into
three groups according to the timing of conversion: Group A (<7 days), Group B (7-13
days), Group C (> 14 days). Comparison between groups was performed to assess intergroup
variabilty.
Results
The mean number of days between DCO and conversion was 6.7±4.52 (range 1-22). We observed
one case of deep infection (1.1%), one case of non-union (1.1%), four cases of superficial
infection (4.3%) and mean time to union was ±1.38 months. Comparison between groups
demonstrated no significant correlation between timing of conversion and development
of superficial or deep infection and non-union, while it highlighted that complexity
of the fracture and longer surgical time of conversion procedure were significantly
higher in Group C.
Conclusions
One-stage conversion to definitive internal fixation within 22 days from DCO is a
safe and feasible procedure, which does not influence the incidence of infection or
non-union.
Keywords
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Article info
Publication history
Published online: September 15, 2020
Accepted:
September 15,
2020
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2020 Elsevier Ltd. All rights reserved.
