Damage control orthopaedics: lessons learned.
Damage control orthopaedics (DCO) is a staged approach for the management of multiply injured patients. It is ideal for trauma patients presenting in an unstable or extremis physiological state. It focuses on the rapid resuscitation of these patients by providing temporary stabilisation of fractures while at the same time reducing the biological load of surgery. Early findings support its usefulness in controlling the lethal triad of hypothermia, acidosis and coagulopathy. Furthermore, recent evidence indicates that it regulates the evolving systemic inflammatory response, reducing the detrimental complications of adult respiratory distress syndrome, multiple organ dysfunction and subsequent mortality. Although DCO has been proven a useful surgical strategy for efficiently managing patients with multiple trauma, further work is required to establish fully its indications, results and cost implications.
Giannoudis
Peter V
PV
Academic Dept of Trauma & Orthopaedics, Leeds General Infirmary, Leeds, UK. pgiannoudi@aol.com
Giannoudi
Marilena
M
Stavlas
Panagiotis
P
D000138:Acidosis / Q000209:etiology / Q000517:prevention & control; D001778:Blood Coagulation Disorders / Q000209:etiology / Q000628:therapy; D002985:Clinical Protocols; D050723:Fractures, Bone / Q000601:surgery; D006801:Humans; D007035:Hypothermia / Q000209:etiology; D015601:Injury Severity Score; D007902:Length of Stay; D009102:Multiple Organ Failure / Q000209:etiology / Q000517:prevention & control; D009104:Multiple Trauma / Q000150:complications / Q000628:therapy*; D019637:Orthopedic Procedures / Q000379:methods*; D018579:Patient Selection; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000517:prevention & control; D012151:Resuscitation / Q000379:methods*; D012308:Risk Management; D016896:Treatment Outcome