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Damage control orthopaedics in polytraumatized patients- current concepts.

Gershon Volpin1,2, Roman Pfeifer3, Jordan Saveski4

  • 1Galilee Medical Faculty Zfat, Bar-Ilan University, Ramat Gan, Israel.

Journal of Clinical Orthopaedics and Trauma
|March 15, 2021
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Summary

Managing fractures in polytraumatized patients requires careful consideration. Early Total Care (ETC) risks systemic inflammatory response syndrome, while Damage Control Orthopedics (DCO) offers an alternative, leading to the refined Safe Definitive Surgery (SDS) concept.

Keywords:
ARDSDamage control orthopaedics (DCO)Early total care (ETC)MOFMultiple fracturesPolytraumaSafe definitive treatment

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Area of Science:

  • Orthopedic Surgery
  • Trauma Management
  • Critical Care Medicine

Background:

  • Fracture management in polytraumatized patients is critical.
  • Early Total Care (ETC) may lead to Systemic Inflammatory Response Syndrome (SIRS), Acute Respiratory Distress Syndrome (ARDS), and Multiple Organ Failure (MOF).
  • Damage Control Orthopedics (DCO) is an accepted alternative focusing on life-saving interventions before definitive fracture fixation.

Purpose of the Study:

  • To summarize historical and current concepts in polytraumatized patient fracture management.
  • To introduce the Safe Definitive Surgery (SDS) concept as a synthesis of ETC and DCO.
  • To highlight the importance of dynamic patient assessment in orthopedic trauma care.

Main Methods:

  • Review of existing literature on fracture management strategies.
  • Analysis of the "first hit" and "second hit" phenomena in polytrauma.
  • Introduction and explanation of the Safe Definitive Surgery (SDS) concept.

Main Results:

  • Immediate fracture fixation (ETC) in unstable patients can exacerbate systemic inflammatory responses.
  • Damage Control Orthopedics (DCO) mitigates risks associated with immediate fixation.
  • Safe Definitive Surgery (SDS) dynamically integrates clinical assessment with surgical timing.

Conclusions:

  • The choice of fracture management strategy (ETC vs. DCO) significantly impacts outcomes in polytraumatized patients.
  • Safe Definitive Surgery (SDS) offers a refined approach, balancing immediate needs with definitive care.
  • Continuous patient assessment is key to optimizing treatment strategies in complex trauma cases.