The Use of “Damage Control Orthopedics” Strategy in the Treatment of Severe Gunshot Wounds of the Limbs

Abstract

Objectives: The objectives of this study were to evaluate the incidence and nature of gunshot wounds of the limbs in the general structure of combat trauma, and study the features of DCO (Damage Control Orthopedics) patient management strategy in the conditions of a regional hospital as a stage of care for this pathology. Background: Limb injuries account for between 52.3% and 60.1% of combat casualties. The problem of surgical management of limb gunshot wounds is of particular relevance at the present stage of active use of firearms. Thus, adequate choice of surgical treatment strategy for limb gunshot wounds is an important condition for preserving life and preventing severe complications in combat casualties. Methods: The study was conducted among 1000 injured from the combat zone during the period from 24.02.22 to 15.04.22. The trauma and orthopedic surgery department of “Dnipropetrovsk Regional Clinical Hospital named after I.I. Mechnikov” mainly performed secondary surgical debridement of wounds, comprehensive surgical and medical prevention of complications in the injured. Injury severity was assessed using the ISS (Injury Severity Score) based on the AIS (Abbreviated Injury Scale), which assesses the severity of injuries to several areas of the body. Results: DCO strategy was used in 287 (55.1%) injured patients in severe and extremely severe condition (16 points or higher on the ISS scale). A total of 602 surgical operations were performed in 287 injured patients. On average, 2.1±0.6 interventions per one injured person were performed. Overall mortality among victims with gunshot wounds of the limbs was 3.6% (19 wounded out of 521). In all cases there were polytrauma (100%), in 4 (21.1%) cases they were through-and-through injuries, in 2 (10.5%) - with the compartment syndrome development. Conclusions: Differentiated DCO strategy in the surgical treatment of the critically and severely injured (16 points and above on the ISS scale) are essential to save the lives of soldiers in the first period of traumatic illness and to prevent complications of the second and third periods of traumatic illness