Damage control orthopaedics: State of the art

Guerado, E.; Bertrand, Maria; Cano, Juan Ramón; Cerván, Ana María; Galán, Adolfo

doi:10.5312/wjo.v10.i1.1

Cited by 43 publications

(19 citation statements)

References 128 publications

(148 reference statements)

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“…Additionally, certain aspects of initial injury types were observed to imply a special risk for secondary complications including SIRS, MOF, sepsis, or ARDS. With DCO treatment, the survival and the rate of complications was improved (170)(171)(172)(173)(174)(175). This observation was supported by a prospective randomized study that showed a reduction of acult lung injuries in borderline patients (12), two supportive trauma registry analyses from the NTDB and Tr_DGU, and a matched pair analysis (162).As a result damage control orthopedics appears to represent a feasible option for patients at special risk and has been applied worldwide, independent of trauma center, geographic or treatment differences (174,(176)(177)(178)(179)(180)(181).…”

Section: Damage Control Orthopaedics (Dco)mentioning

confidence: 99%

Timing of major fracture care in polytrauma patients – An update on principles, parameters and strategies for 2020

Pape

Halvachizadeh

Leenen

et al. 2019

Injury

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Objectives Sustained changes in resuscitation and transfusion management have been observed since the turn of the millennium, along with an ongoing discussion of surgical management strategies. The aims of this study are threefold: a) to evaluate the objective changes in resuscitation and mass transfusion protocols undertaken in major level I trauma centers; b) to summarize the improvements in diagnostic options for early risk profiling in multiply injured patients and c) to assess the improvements in surgical treatment for acute major fractures in the multiply injured patient. Methods I. A systematic review of the literature (comprehensive search of the MEDLINE, Embase, PubMed, and Cochrane Central Register of Controlled Trials databases) and a concomitant data base (from a single Level I center) analysis were performed. Two authors independently extracted data using a pre-designed form. A pooled analysis was performed to determine the changes in the management of polytraumatized patients after the change of the millennium. II. A data base from a level I trauma center was utilized to test any effects of treatment changes on outcome. Inclusion criteria: adult patients, ISS > 16, admission < less than 24 h post trauma. Exclusion: Oncological diseases, genetic disorders that affect the musculoskeletal system. Parameters evaluated were mortality, ICU stay, ICU complications (Sepsis, Pneumonia, Multiple organ failure). Results I. From the electronic databases, 5141 articles were deemed to be relevant. 169 articles met the inclusion criteria and a manual review of reference lists of key articles identified an additional 22 articles. II. Out of 3668 patients, 2694 (73.4%) were male, the mean ISS was 28.2 (SD 15.1), mean NISS was 37.2 points (SD 17.4 points) and the average length of stay was 17.0 days (SD 18.7 days) with a mean length of ICU stay of 8.2 days (SD 10.5 days), and a mean ventilation time of 5.1 days (SD 8.1 days). Both surgical management and nonsurgical strategies have changed over time. Damage control resuscitation, dynamic analyses of coagulopathy and lactate clearance proved to sharpen the view of the worsening trauma patient and facilitated the prevention of further complications. The subsequent surgical care has become safer and more balanced, avoiding overzealous initial surgeries, while performing early fixation, when patients are physiologically stable or rapidly improving. Severe chest trauma and soft tissue injuries require further evaluation. Conclusions Multiple changes in management (resuscitation, transfusion protocols and balanced surgical care) have taken place. Moreover, improvement in mortality rates and complications associated with several factors were also observed. These findings support the view that the management of polytrauma patients has been substantially improved over the past 3 decades.

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Section: Damage Control Orthopaedics (Dco)mentioning

confidence: 99%

Timing of major fracture care in polytrauma patients – An update on principles, parameters and strategies for 2020

Pape

Halvachizadeh

Leenen

et al. 2019

Injury

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“…Twenty-two patients with multiple fractures at other anatomical sites were staged, treated, and xed according to the Damage control orthopedics (DCO) surgical strategy [18]. Another 9 patients combined with rib fractures received conservative treatment.…”

Section: Resultsmentioning

confidence: 99%

Failure of Internal Fixation of The Anterior Ring For Unstable Pelvic Fractures, The Experience of A Single Institute

Zhang

Liu

et al. 2021

Preprint

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Background: This study aimed to share our experience of anterior ring fixation failure for unstable pelvic fractures and propose corresponding treatment strategies. Materials: From January 2009 to December 2018, 93 patients with pelvic fractures were retrospectively reviewed. Patients with failure of the anterior ring internal fixation within 3 months after initial surgery were analyzed. Quality of reduction was evaluated using the Majeed scoring system.Results: According to the Tile classification of fracture, there were 23 cases of type B1, 17 cases of type B2, 11 cases of type B3, 28 cases of type C1, 6 cases of type C2, and 8 cases of type C3. The duration from injury to pelvic internal fixation ranged from 5-28 days. Seven out of 93 patients experienced failure of internal fixation of the anterior pelvic ring within 3 months, including 2 patients fixed with an external fixator and 5 patients were fixed with a plate. Five patients undergoing revision surgery were followed up for 6-36 months with an average of 18 months. According to Majeedscore at the last follow-up, there were 2 cases of excellent, 2 cases of good, 1 case of fair, and the excellent and good rate reached 80%.Conclusion: The treatment of complicated unstable pelvic fractures requires early multidisciplinary cooperation, proper management of hemodynamic stability and other comorbidities, and performing internal fixation surgery within 2 weeks. It is necessary to make a preoperative plan and stabilize the posterior ring first, avoiding a single steel plate crossing the pubic symphysis.

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“…Of note, some studies also reported the onset of FES prior to surgery, even within 24 h after the initial trauma [ 19 , 82 , 83 ]. We hypothesize that the inclusion of endpoints of resuscitation [ 84 ], application of lactate clearance [ 85 ], and revised criteria for patients at special risk (borderline patients) have played a role [ 86 ]. We are aware that FES will occur in some patients irrespective of the timing of the definitive treatment [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

Incidence of Fat Embolism Syndrome in Femur Fractures and Its Associated Risk Factors over Time—A Systematic Review

Lempert¹,

Halvachizadeh²,

Ellanti

et al. 2021

JCM

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Background: Fat embolism (FE) continues to be mentioned as a substantial complication following acute femur fractures. The aim of this systematic review was to test the hypotheses that the incidence of fat embolism syndrome (FES) has decreased since its description and that specific injury patterns predispose to its development. Materials and Methods: Data Sources: MEDLINE, Embase, PubMed, and Cochrane Central Register of Controlled Trials databases were searched for articles from 1 January 1960 to 31 December 2019. Study Selection: Original articles that provide information on the rate of FES, associated femoral injury patterns, and therapeutic and diagnostic recommendations were included. Data Extraction: Two authors independently extracted data using a predesigned form. Statistics: Three different periods were separated based on the diagnostic and treatment changes: Group 1: 1 January 1960–12 December 1979, Group 2: 1 January 1980–1 December 1999, and Group 3: 1 January 2000–31 December 2019, chi-square test, χ2 test for group comparisons of categorical variables, p-value < 0.05. Results: Fifteen articles were included (n = 3095 patients). The incidence of FES decreased over time (Group 1: 7.9%, Group 2: 4.8%, and Group 3: 1.7% (p < 0.001)). FES rate according to injury pattern: unilateral high-energy fractures (2.9%) had a significantly lower FES rate than pathological fractures (3.3%) and bilateral high-energy fractures (4.6%) (p < 0.001). Conclusions: There has been a significant decrease in the incidence of FES over time. The injury pattern impacts the frequency of FES. The diagnostic and therapeutic approach to FES remains highly heterogenic to this day.

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Damage control orthopaedics: State of the art

Cited by 43 publications

References 128 publications

Timing of major fracture care in polytrauma patients – An update on principles, parameters and strategies for 2020

Timing of major fracture care in polytrauma patients – An update on principles, parameters and strategies for 2020

Failure of Internal Fixation of The Anterior Ring For Unstable Pelvic Fractures, The Experience of A Single Institute

Incidence of Fat Embolism Syndrome in Femur Fractures and Its Associated Risk Factors over Time—A Systematic Review

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