Application of the Damage Control Orthopaedics Principle in the Management of Polytrauma at Luth, Lagos

Damage control orthopaedics (DCO) is a staged surgical strategy designed to stabilise life-threatening injuries while minimising the physiological insult of definitive orthopaedic surgery in polytrauma patients. This prospective cohort study evaluates the application and effectiveness of the DCO principle in the management of polytrauma patients admitted to Lagos University Teaching Hospital (LUTH), South West Nigeria. Over a twelve-month period, polytrauma patients with an Injury Severity Score (ISS) of 16 or above who undergo DCO will be enrolled alongside a comparison group managed with early total care. Primary outcomes include 30-day mortality, incidence of systemic inflammatory response syndrome, multiple organ dysfunction syndrome, and intensive care unit length of stay. Secondary outcomes encompass time to definitive fracture fixation and orthopaedic complication rates. The study will assess adherence to DCO decision-making criteria and the availability of necessary resources including external fixators, intensive care beds, and blood products. It is hypothesised that DCO is associated with lower mortality in patients with ISS greater than 25. Findings will be reported to the trauma and orthopaedic teams at LUTH to refine polytrauma management protocols. This research contributes to the evidence base for damage control strategies in low-resource tertiary trauma centres in South West Nigeria, where definitive care resources are constrained. Keywords: damage control orthopaedics, polytrauma, injury severity score, LUTH, trauma management.