| Summary: | High energy lower limb trauma presents wide spectrum of challenges. The principles of damage control surgery have inspired the so called staged approach towards these difficult injuries. We present our experience with this new treatment modality and try to analyse its indications and limitations.
The span of the study reached 11 years. We operated 33 fractures of 32 patients (4 distal femoral fractures, 18 proximal and 11 distal tibial fractures). The average age was 45,7 years (26-71). All of the fractures resulted from high energy trauma.
The staged approach was implemented on lower limb fractures complicated with soft tissue damage. The index surgery typically consisted of the application of a bridging external fixator. The second step was either a formal open reduction and plating, or a less invasive fixation with cannulated screws and a hybrid ex. fix.
All 33 fractures united for a mean period of 16 weeks (12-30 weeks).
Fifteen patients had excellent, 11 had good, 5 had average and two had poor ratings. There were no serious intraoperative complications, deep infections, septic arthritis or osteomyelitis. Skin necrosis developed in 3 cases. There were four cases of delayed healing. Pin track infection occurred in 10 patients. Late articular collapse was noted in 2 cases. Three knees had medio-lateral instability.
Staged approach offers favourable balance between safety and functional recovery. The decision about the type of definitive fixation depends on the morphology and localization of the fracture, as well as on the experience and equipment of the treating surgical team.
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