title: Initial management of complex hand injuries in military or austere environments: how to defer and prepare for definitive repair?
abstract: The damage control orthopedics (DCO) concept is a sequential surgical management strategy indicated when ideal primary treatment is not possible or suitable. DCO principles are routinely applied to hand traumas in wartime practice, but could also be useful in a civilian setting when immediate specialized management cannot be carried out.
  
  
  
  The authors report three typical observations of soldiers treated for a complex hand trauma on the field by orthopedic surgeons from the French Military Health Service (FMHS). Application of the hand DCO concept is analyzed and discussed considering the literature and the FMHS experience.
  
  
  
  With regards to treating the hand, DCO necessitates a meticulous debridement with precise wound assessment, the frequent use of a primary definitive internal fixation by K-wires, and the possibility of a temporary coverage. These simple and fast procedures help avoid infection and prepare the hand for secondary repair.
  
  
  
  Hand DCO can be applied by any surgeon in various situations: in association with polytrauma, complex injuries requiring multiple reconstructions, or delayed transfer to a specialized center.
authors.affiliation: Clinic of Traumatology and Orthopedics, Percy Military Hospital, Clamart, France.
authors.forename: Camille
authors.initials: C
authors.lastname: Choufani
authors.affiliation: Clinic of Traumatology and Orthopedics, Begin Military Hospital, Saint-Mandé, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Barbier
authors.affiliation: Clinic of Traumatology and Orthopedics, Percy Military Hospital, Clamart, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Grosset
authors.affiliation: Clinic of Traumatology and Orthopedics, Percy Military Hospital, Clamart, France.
authors.forename: James Charles
authors.initials: JC
authors.lastname: Murison
authors.affiliation: Clinic of Traumatology and Orthopedics, Begin Military Hospital, Saint-Mandé, France.|French Military Health Service Academy, Ecole du Val-de-Grâce, Paris, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Ollat
authors.affiliation: Clinic of Traumatology and Orthopedics, Percy Military Hospital, Clamart, France.|French Military Health Service Academy, Ecole du Val-de-Grâce, Paris, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Rigal
authors.affiliation: Clinic of Traumatology and Orthopedics, Percy Military Hospital, Clamart, France. laurent_tom2@yahoo.fr.|French Military Health Service Academy, Ecole du Val-de-Grâce, Paris, France. laurent_tom2@yahoo.fr.|Service de Chirurgie Orthopédique, Traumatologie et Chirurgie Réparatrice des Membres, 101 avenue Henri Barbusse, 92140, Clamart, France. laurent_tom2@yahoo.fr.
authors.forename: Laurent
authors.initials: L
authors.lastname: Mathieu
mesh_terms: D000328:Adult; D003646:Debridement / Q000379:methods; D004638:Emergency Treatment / Q000379:methods; D005593:Fracture Fixation, Internal / Q000379:methods*; D006225:Hand / Q000601:surgery; D006230:Hand Injuries / Q000601:surgery*; D006801:Humans; D008297:Male; D008889:Military Personnel / Q000706:statistics & numerical data; D009104:Multiple Trauma / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*
keywords: Damage control surgery; Hand trauma; Military; Orthopedic surgery; Polytrauma