Effect of Damage Control Orthopedics versus Early Total Care on Mortality and Functional Outcomes in Polytrauma Patients: A Prospective Observational Study

Abstract

Background: Polytrauma is a leading cause of morbidity and mortality in developing countries. Orthopaedic injuries are common in these
patients and significantly influence survival and long-term functional outcomes. Two principal management strategies damage control orthopaedics
(DCO) and early total care (ETC) are used based on patient physiology and injury severity.
Aim: To compare the effect of damage control orthopaedics versus early total care on mortality and functional outcomes in polytrauma patients
presenting to a tertiary care referral centre in Bihar.
Methodology: This prospective observational study included 102 polytrauma patients over a 6-month period. Patients were managed using
either DCO (n=52) or ETC (n=50) based on clinical status. Outcomes assessed included mortality, complications (ARDS, sepsis, MODS),
ICU and hospital stay, fracture union, and functional outcome using the Lower Extremity Functional Scale at 3 months. Statistical analysis was
performed using SPSS version 20.0 with p < 0.05 considered significant.
Results: Patients in the DCO group had significantly higher injury severity scores. Mortality was higher in the DCO group (23.1%) compared
to ETC (12%). The DCO group had significantly longer ICU stay, ventilator days, and hospital stay, along with higher sepsis rates. Functional
outcomes, time to union, and early mobilization were significantly better in the ETC group.
Conclusion: DCO is essential for physiologically unstable patients, whereas ETC offers better functional recovery and reduced hospital burden
in stable polytrauma patients. A physiological status guided, individualized treatment approach is recommended.