The Evolution of Damage Control Orthopedics

Improved Diagnosis of Infection Associated with Osteosynthesis by Use of Sonication of Fracture Fixation Implants

“…Indeed, the acute management of bone fractures in trauma patients has evolved steadily, and there is an expanded indication for osteosynthesis, with the aim of early stabilization of the fractures. Depending upon the physiological condition of the patient, especially those with unstable polytrauma and significant lower extremity injuries, surgeons must choose the less aggressive external fixation first step for fracture stabilization (2). Once the adequate local wound debridement is ensured, which includes the removal of all dead and infected tissues and the stabilization of the systemic clinical condition of the patient, secondary major osteosynthesis is then performed with either plates and screws or intramedullary nails (3).…”

Damage control orthopaedics: Variability of construct design for external fixation of the lower extremity and implications on cost

“…The literature has evolved over the last few decades to better define the appropriate timing of definitive fixation for these patients [1][2][3][4]. Early findings support DCO in managing the lethal triad of hypothermia, acidosis and coagulopathy [1,2].…”

“…Others purport a low rate of acute respiratory distress syndrome (ARDS) with the infrequent use of DCO, suggesting damage control orthopaedics may result in an unnecessary delay of definitive fixation, as well as a longer hospital stay [3]. However, the consequence of implementing early total care in an inappropriate patient may result in ARDS, and potentially death, a far more grave result than unnecessary delays or longer hospital stays [4]. Although clinical situations for which immediate definitive fixation do exist in the poly-traumatized patient, multiple circumstances may point to DCO as the safest choice [4].…”

“…However, the consequence of implementing early total care in an inappropriate patient may result in ARDS, and potentially death, a far more grave result than unnecessary delays or longer hospital stays [4]. Although clinical situations for which immediate definitive fixation do exist in the poly-traumatized patient, multiple circumstances may point to DCO as the safest choice [4].…”

The Pendulum of Damage Control Laparotomy

“…The results from such an approach were impressive resulting in decreased mortality [4]. Similarly the concept of damage control was extended to orthopedic and thoracic trauma surgery [7][8][9]. DCL was also not only being applied to trauma patients but its use was extended to emergency general surgery cases where the indications and outcomes were less clear [10].…”