[Damage control orthopedics].
BACKGROUND
In the management of patients with multiple injuries, the concept of damage control orthopedics (DCO) is still a matter of controversy. Thus, the clinical value of DCO remains unclear and should be evaluated on an evidence-based level by a review of the current literature.


RESULTS
The work of various authors has demonstrated an association between injury severity and the clinical immuno-inflammatory response and its prognostic relevance regarding organ dysfunction or organ failure and clinical outcome. Research data published by the authors and other investigators have clearly demonstrated an additional inflammatory response caused by surgical trauma which is significantly higher after primary intramedullary fracture treatment than after external fracture stabilization. In contrast, a generally minor inflammatory response seems to be associated with intramedullary nailing for secondary conversion osteosynthesis. Three retrospective cohort studies have shown a reduction of organ dysfunction and an improvement of survival with the DCO approach. Simultaneously, it was demonstrated that primary external fracture fixation and secondary conversion to definite osteosynthesis is not associated with an increased rate of local or systemic complications.


CONCLUSIONS
The advocates of DCO claim that patients with multiple injuries including severe brain and chest injuries as well as those with an unstable cardiopulmonary or circulatory condition are at high risk of developing a severe systemic immuno-inflammatory reaction during early total fracture care. Therefore, they recommend primary minimally invasive external fracture stabilization in these patients to avoid additional surgical trauma and that definitive secondary fracture care should be performed after medical stabilization of the patient in intensive care.
Nast-Kolb
D
D
Klinik für Unfallchirurgie, Universitätsklinikum, Essen. prof.nast-kolb@medizin.uni-essen.de
Ruchholtz
S
S
Waydhas
C
C
Schmidt
B
B
Taeger
G
G
D003422:Critical Care / Q000379:methods; D005592:Fracture Fixation / Q000379:methods*; D050723:Fractures, Bone / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D009104:Multiple Trauma / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D009985:Orthopedics / Q000379:methods*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*