Damage control orthopaedics: lessons learned

Giannoudis, Peter V.; Giannoudi, Marilena; Stavlas, Panagiotis

doi:10.1016/j.injury.2009.10.036

Cited by 100 publications

(39 citation statements)

References 50 publications

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“…Especially in the presence of chest injuries, which is relatively common in this group of patients, or in case of significant pre-existing conditions, the concept of providing temporary stabilisation of fractures with external fixation and reducing the additional physiological burden ('second hit') of a prolonged and more invasive surgical procedure [60] is rational. Although DCO is indicated in the case of unstable or extremis physiological state in adult trauma patients [61], the indications may be even broader in the elderly, due to their reduced physiologic reserves. Furthermore, as there is evidence that the DCO approach controls the lethal triad of hypothermia, acidosis and coagulopathy, and regulates the evolving systemic inflammatory response by reducing the complications of adult respiratory distress syndrome and multiple organ dysfunction [61], such an approach could reduce mortality and improve outcome, since these complications are less tolerated by the elderly patients.…”

Section: Triage Of Elderly Trauma Patients and Trauma Team Activationmentioning

confidence: 99%

“…Although DCO is indicated in the case of unstable or extremis physiological state in adult trauma patients [61], the indications may be even broader in the elderly, due to their reduced physiologic reserves. Furthermore, as there is evidence that the DCO approach controls the lethal triad of hypothermia, acidosis and coagulopathy, and regulates the evolving systemic inflammatory response by reducing the complications of adult respiratory distress syndrome and multiple organ dysfunction [61], such an approach could reduce mortality and improve outcome, since these complications are less tolerated by the elderly patients. A basic algorithm for the management of the elderly polytrauma patients is presented in Fig.…”

Section: Triage Of Elderly Trauma Patients and Trauma Team Activationmentioning

confidence: 99%

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Polytrauma in the elderly: specific considerations and current concepts of management

Dimitriou

Calori

Giannoudis

2011

Eur J Trauma Emerg Surg

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With an aging and more active older population, an increased incidence of elderly trauma patients, including severely injured geriatric patients, is anticipated. Poorer functional outcomes and increased mortality and morbidity rates in these patients compared to their younger counterparts may be inevitable due to the associated pre-existing medical conditions and the reduced physiological reserves and compensatory mechanisms secondary to aging. However, mortality and complication rates can be reduced, and outcomes can be improved, when prompt and aggressive treatment is provided. Knowledge of the specific issues, challenges and the distinctive injury patterns of this unique trauma population is important when treating elderly polytrauma patients. In the herein study, the special needs of these patients and the current concepts on their management are summarised. Research in this field is ongoing in order to develop advanced management strategies to optimise outcomes. Overall, these patients should not be treated as "older adults", but as a special population with special considerations and the trauma care should be tailored to meet their specific needs.

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Section: Triage Of Elderly Trauma Patients and Trauma Team Activationmentioning

confidence: 99%

Section: Triage Of Elderly Trauma Patients and Trauma Team Activationmentioning

confidence: 99%

Polytrauma in the elderly: specific considerations and current concepts of management

Dimitriou

Calori

Giannoudis

2011

Eur J Trauma Emerg Surg

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“…Although the overall incidence of femoral shaft fractures continues to be less in comparison to other long bone fractures (American population-13/100000 [1] , European population-10 to 13/100000 [2][3][4][5][6][7] the strain on resources as well as the amount of DALY is significant. This is especially true in a resource scarce developing nation with an enormous population like India.…”

Section: Introductionmentioning

confidence: 99%

A comparison of closed intramedullary nailing with open intramedullary nailing in femoral shaft fractures of adults

Kisan¹,

Samant²

2018

Int. J. Orthop. Sci.

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The overall incidence of femoral shaft fractures as well as their burden on society continues to be significant. The purpose of our study was to assess the results of intramedullary nailing of femoral shaft fractures by both open and closed methods. We made a retrospective study of 64 femoral shaft fractures that had been operated between 2012 to 2016. The average healing time as well as the surgical operative duration was higher in open intramedullary nailing in comparison to the closed group. We believe that a more comprehensive study may be required for validation of these results.

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“…However, patients who are hemodynamically unstable, hypothermic, who have coagulation abnormalities or poor oxygenation due to traumatic lung injury have increased rates of acute lung injury after intermedullary reaming. If these conditions cannot be reversed with adequate resuscitation, these patients benefit from a protocol of damage control orthopaedics consisting of initial external fixation for transient stabilization followed by delayed definitive fracture fixation stabilization followed by delayed definitive fracture fixation (Bone & Giannoudis, 2011;Giannoudis et al, 2009;O'Toole et al, 2005, Hardwood et al, 2005Sears et al, 2009;Pape et al, 2009;. Although inflammation is potentially harmful, with the ability to induce both local and systemic responses, it is also necessary to initiate the healing process.…”

Section: Systemic Responsementioning

confidence: 99%