[Damage control orthopaedics in polytraumatised patients with lower leg injuries]

In polytraumatised patients, fracture management depends on the overall injury severity. For decision making, patients are grouped in one of four categories (STABILE, BORDERLINE, INSTABLE and IN EXTREMIS). STABILE patients should and BORDERLINE patients may undergo primary definitive fracture stabilisation; in contrast, this is not recommended for INSTABLE or IN EXTREMIS patients. The marginal soft tissue envelope of the tibia predisposes for open fractures, compartment syndrome, and wound infections. Therefore the management of lower leg injuries is demanding, especially in polytraumatised patients. Bilateral tibia fractures and ipsilateral tibia and femur fractures represent a special entity. For these injuries special algorithms, which consider the soft tissue status of the tibia and the overall injury severity, have been developed. The indication for fasciotomy covers a wide field and may be performed prophylactically. The decision for amputation is based on the patient's general condition and the soft-tissue and neurovascular status. Scoring systems are useful for decision making, however individual decisions should be made.