title: Physiological assessment of the polytrauma patient: initial and secondary surgeries.
abstract: The timing of fracture fixation in polytrauma patients has been debated for a long time. The decision between DCO (damage control orthopaedics) and ETC (early total care) is a difficult dilemma. Overzealous ETC in haemodynamically compromised patients with significant chest and head injuries can be detrimental. It has been shown, however, that early fracture fixation has a trend towards better outcome in patients with less severe injuries. Delaying all orthopaedic surgery in critically injured patients can be a safe alternative, but has several disadvantages like longer ICU stay and septic complications. The literature shows equivocal evidence for both settings. This article will summarize the historical background and controversies regarding patient assessment and decision making during the treatment of polytrauma patients. It will also give guidance for choosing DCO versus ETC in the clinical setting.
authors.affiliation: Department of Traumatology, Division of Surgery, John Hunter Hospital and University of Newcastle, Newcastle, NSW, 2310, Australia.
authors.forename: N
authors.initials: N
authors.lastname: Enninghorst
authors.affiliation: Department of Trauma, Doha General Hospital, Doha, Qatar.
authors.forename: R
authors.initials: R
authors.lastname: Peralta
authors.affiliation: Department of Traumatology, Division of Surgery, John Hunter Hospital and University of Newcastle, Newcastle, NSW, 2310, Australia.
authors.forename: O
authors.initials: O
authors.lastname: Yoshino
authors.affiliation: Department of Orthopaedic Trauma, University of Aachen Medical Center, Pauwels Str. 30, Aachen, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Pfeifer
authors.affiliation: Department of Orthopaedic Trauma, University of Aachen Medical Center, Pauwels Str. 30, Aachen, Germany.
authors.forename: H C
authors.initials: HC
authors.lastname: Pape
authors.affiliation: Department of Traumatology, Division of Surgery, John Hunter Hospital and University of Newcastle, Newcastle, NSW, 2310, Australia.
authors.forename: B M
authors.initials: BM
authors.lastname: Hardy
authors.affiliation: Department of Traumatology, Division of Surgery, John Hunter Hospital and University of Newcastle, Newcastle, NSW, 2310, Australia.
authors.forename: D C
authors.initials: DC
authors.lastname: Dewar
authors.affiliation: Department of Traumatology, Division of Surgery, John Hunter Hospital and University of Newcastle, Newcastle, NSW, 2310, Australia. Zsolt.Balogh@hnehealth.nsw.gov.au.
authors.forename: Z J
authors.initials: ZJ
authors.lastname: Balogh
keywords: Physiological assessment; Polytrauma; Timing of surgery
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