Demystifying damage control in musculoskeletal trauma

Area of Science:

• Orthopaedic trauma surgery
• Surgical critical care
• Trauma resuscitation

Background:

• Operative fracture management benefits major trauma patients.
• Early total care concerns arose due to potential for 'second hit' phenomenon.
• Damage control orthopaedics (DCO) was developed for critically injured patients.

Purpose of the Study:

• To refine treatment options for major trauma patients based on physiological response.
• To advocate for individualized care in trauma fracture management.
• To introduce the 'safe definitive fracture surgery' (SDFS) or 'early appropriate care' (EAC) approach.

Main Methods:

• Review of large-scale retrospective data on fracture fixation timing.
• Analysis of physiological responses to major trauma and surgical interventions.
• Development of a training course for senior surgeons on DCO and EAC principles.

Main Results:

• Retrospective reviews suggest early definitive fixation benefits most major trauma patients.
• Patient selection based on resuscitation response is crucial for optimal outcomes.
• EAC/SDFS aims to provide individualized, timely fracture care.

Conclusions:

• Refined understanding of trauma response necessitates individualized treatment strategies.
• Appropriate patient selection is key to successful early definitive fracture fixation.
• The DCO course equips surgeons with skills for DCO and EAC decision-making.