Comparing Early Total Care and Damage Control Orthopedics in Polytrauma Patients: A Systematic Review and Meta-Analysis of the Outcomes

Abstract

Optimal timing of definitive fracture fixation in polytrauma patients remains controversial. This study aimed to compare clinical outcomes between Early Total Care (ETC) and Damage Control Orthopedics (DCO). A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. PubMed, CENTRAL, Scopus, and Web of Science were searched through August 2025. Observational and interventional studies comparing ETC and DCO were included. Outcomes included mortality, sepsis, acute respiratory distress syndrome (ARDS), multiple organ dysfunction syndrome (MODS), infections, delayed union, hospital stay, and number of surgical procedures. Methodological quality of observational studies was assessed using the Newcastle-Ottawa Scale, while risk of bias for randomized controlled trials was assessed using the Cochrane RoB 2 tool. The NIH Quality Assessment Tool was used for the included case series. Twenty studies (18,852 patients) were analyzed. ETC was associated with reduced hospital stay (WMD = -4.91 days, 95% CI: -6.89 to -2.93), surgical procedures (WMD = -3.39, 95% CI: -3.57 to -3.22), sepsis risk (OR = 0.63, 95% CI: 0.48 to 0.81), and delayed union (OR = 0.23, 95% CI: 0.06 to 0.93). No significant differences existed for mortality (OR = 0.59, 95% CI: 0.28 to 1.24), MODS (OR = 0.85, 95% CI: 0.55 to 1.30), ARDS (OR = 1.18, 95% CI: 0.64 to 2.17), or infections (OR = 1.38, 95% CI: 0.92 to 2.07). ETC was associated with a lower risk of sepsis, shorter hospital stay, and fewer surgical procedures in patients with polytrauma. Major complications and mortality, however, were similar between the two approaches. These findings highlight the importance of patient selection and individualized decision-making based on physiological status.