Damage control orthopaedics

Abstract

Musculoskeletal injuries represent the most common lesions requiring surgical intervention in polytrauma patients and in long-term survivors present challenging scenarios in terms of functional outcomes and quality of life (Balogh et al., Lancet 380(9847):1109- 191, 2012; Banerjee et al., Injury 44(8):1015- 212, 2013). More than 70% of all patients ith major trauma need at least one orthopaedic surgical procedure (Balogh, ANZ J Surg 80(3):119-21, 2010) and extremity injuries are associated with higher rates of blood transfusions, longer hospital stays and overall worse outcomes (Banerjee et al., Injury 44(8):1015-212, 2013; Pape et al., J Trauma 69(5):1243-514, 2010; Ringburg et al., J Trauma 70(4):916-22, 2011; Gabbe et al., Ann Surg 255(6):1009-15, 2012). The term 'damage control orthopaedics' (DCO) represents a staged surgical approach to the management of selected polytrauma patients with orthopaedic injuries (Scalea et al., J Trauma 48(4):613-21, 2000; Giannoudis et al., Injury 40(Suppl 4):S47-52, 2009). The principle of DCO is to provide adequate skeletal stability of major fractures to prevent further bleeding/soft tissue damage, potential fat embolism and to permit better positioning of the multiple injured patient without the potential adverse effects of early definitive fixation (Pape et al., J Trauma 53(3):452-61, 2002; Roberts et al., Instr Course Lect 54:447-62, 2005). This abbreviated procedure allows for resuscitation following the initial hit of severe trauma and optimises patient physiology for later definitive fixation (Taeger et al., J Trauma 59(2):409-16, 2005). In the context of improved trauma resuscitation and understanding of trauma physiology, the indications for DCO have developed since its initial description (Scalea et al., J Trauma 48(4):613-21, 2000). Today DCO may be implemented in the prevention of physiological deterioration in the critically injured patient (patient mode), in the management of complex periarticular injuries with critical soft tissue damage (limb mode) and in settings of inadequate surgical expertise, equipment or manpower (resource mode).