Patient selection: Orthopedic approach in isolated injuries

Abstract

In an era of hand transplantation, the Lower Extremity Assessment Project (LEAP) study data have created increased pressure for limb salvage rather than immediate amputation for complex lower extremity injury. Limb salvage is performed frequently using limb damage control (LDC). LDC is the specific application of the principles of damage control orthopedics to the complex lower extremity injury. Like damage control orthopedics for the polytrauma patient with long bone fractures, LDC uses initial damage control spanning external fixation and adjunctive soft tissue techniques (antibiotic bead pouches and negative pressure dressings), antibiotic nails after prolonged external fixation as a bridge to intramedullary nailing, and staged definitive osteosynthesis. © 2010 Springer-Verlag New York.