Damage-Control Orthopedics Versus Early Total Care in the Treatment of Borderline High-Energy Pelvic Fractures

The care of multiply injured patients with orthopedic injuries has evolved from prolonged periods in traction to early total care (ETC). ETC is advantageous in ease of nursing care and aiding patient recovery. However, concerns have been raised that this ‘second hit’ of surgery places these severely injured patients at risk of excessive inflammatory responses that can lead to systemic inflammatory response syndrome (SIRS). Damage control was initially used in abdominal trauma but has been adapted for use in orthopedics. The mainstay of treatment involves external fixation of long bone and pelvic fractures which acts to defer definitive fixation until physiologic stability is restored. The indications for implementing each approach are not clear and this article provides a narrative review of the topic.

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Early Total Care versus Damage Control: Current Concepts in the Orthopedic Care of Polytrauma Patients

ISRN Orthopedics ◽

10.1155/2013/329452 ◽

2013 ◽

Vol 2013 ◽

pp. 1-9 ◽

Cited By ~ 14

Author(s):

Ratto Nicola

Keyword(s):

Pelvic Ring ◽

Damage Control ◽

Femoral Shaft ◽

Damage Control Orthopedics ◽

Early Total Care ◽

Orthopedic Patient ◽

Total Care ◽

Orthopedic Care ◽

Polytrauma Patients ◽

Polytrauma Patient

The management of the polytraumatized orthopedic patient remains a challenging issue. In recent years many efforts have been made to develop rescue techniques and to promote guidelines for the management of these patients. Currently controversies persist between two orthopedic approaches: the Early Total Care and the Damage Control Orthopedics. An overview of the current literature on the orthopedic management of polytrauma patient is provided. Subsequently, femoral shaft fractures, representing extremely common lesions, and pelvic ring injuries, that are associated with a high mortality rate, are analyzed in detail.

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Damage control orthopaedics vs early total care in hip fractures: Is 36 hours too soon?

Injury Extra ◽

10.1016/j.injury.2012.07.278 ◽

2012 ◽

Vol 43 (10) ◽

pp. 99

Author(s):

L. Murphy ◽

S. McKenna ◽

D. Shirley

Keyword(s):

Hip Fractures ◽

Damage Control ◽

Damage Control Orthopaedics ◽

Early Total Care ◽

Total Care

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Training in the practical application of damage control and early total care operative philosophy – perceptions of UK orthopaedic specialist trainees

Annals of The Royal College of Surgeons of England ◽

10.1308/003588410x12518836440045 ◽

2010 ◽

Vol 92 (2) ◽

pp. 154-158 ◽

Cited By ~ 6

Author(s):

WGP Eardley ◽

DM Taylor ◽

PJ Parker

Keyword(s):

External Fixation ◽

Damage Control ◽

Practical Application ◽

Web Based ◽

High Exposure ◽

Orthopaedic Surgeons ◽

Early Total Care ◽

Total Care ◽

High Level ◽

Optimum Management

INTRODUCTION Despite improvements in the outcome of individuals sustaining significant injury, the optimum management of fractures in traumatised patients remains an area of debate and publication. There is, however, a paucity of studies regarding the specifics of acquired experience and training of junior orthopaedic surgeons in the practical application of these skills. Our null hypothesis is that, despite alteration in surgical training, the perceived confidence and adequacy of training of UK orthopaedic specialist trainees in the application of damage control orthopaedics (DCO) and early total care (ETC) philosophy is unaffected. PATIENTS AND METHODS A web-based survey was sent to a sample of orthopaedic trainees. From 888 trainees, 222 responses were required to achieve a 5% error rate with 90% confidence. RESULTS A total of 232 responses were received. Trainees reported a high level of perceived confidence with both external fixation and intramedullary devices. Exposure to cases was sporadic although perceived training adequacy was high. A similar pattern was seen in perceived operative role with the majority of trainees expecting to be performing such operations, albeit under varying levels of supervision. In a more complicated case of spanning external fixation for a ‘floating knee, trainees reported a decreased level of perceived confidence and limited exposure. One-third of trainees reported never having been involved in such a case. In contrast to nationally collated logbook data, exposure to and perceived confidence in managing cases involving ETC and DCO were similar. CONCLUSIONS Despite changes in the training of junior orthopaedic surgeons, trainee-reported confidence and adequacy of training in the practical application of DCO and ETC was high. Exposure to cases overall was, however, seen to be limited and there was a suggestion of disparity between current operative experiences of trainees and that recorded in the national trainee logbook.

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Experimental evaluation of the effectiveness of a damage control surgery in combined radiation-mechanical injuries

Medico-Biological and Socio-Psychological Problems of Safety in Emergency Situations ◽

10.25016/2541-7487-2019-0-1-98-105 ◽

2019 ◽

pp. 98-105

Author(s):

A. B. Seleznev ◽

A. M. Nosov ◽

V. A. Kozyaev ◽

A. N. Grebenyuk

Keyword(s):

Blood Loss ◽

Damage Control ◽

Damage Control Surgery ◽

Laboratory Animals ◽

Average Life Expectancy ◽

Behavioral Reactions ◽

Early Total Care ◽

Proposed Model ◽

Total Care ◽

Care Surgery

Relevance. Currently, damage control surgery (DCS) is actively used in polytrauma. However, data on the effectiveness of this tactic for combined radiation-mechanical injuries (CRMI) in the available literature was not found.Objective. To develop a model of CRMI on small laboratory animals (rabbits), which allows studying the effectiveness of the use of DCS in comparison with the early total care surgery tactics.Methods. A model of a severe CRMI was proposed. The animals were subjected to a generally uniform short-term gammairradiation, and then they suffered a liver injury on the background of blood loss of 40% of the blood volume and hypothermia. After modeling the lesion, a comparison was made of the effectiveness of the tactics of the DCS and the early total care surgery tactics. During the study, the following indicators were evaluated: the average life expectancy and mortality of animals, changes in the cellular composition of peripheral blood, features of behavioral reactions to irradiation, the amount of blood loss during the implementation of the surgical intervention.Results and their analysis. The experiment showed that the tactics of the DCS have an advantage over the traditional tactics of a one-time exhaustive operation in the case of the CRMI. When performing DCS, there was no death of rabbits on the 1st day after the operation, when implementing early total care surgery - 3 rabbits died, besides, the mortality was absolute, while with DCS one rabbit survived (12.5%). The final operation at the DCS occurs prior to the beginning of the acute period of CRMI, which corresponds to the requirements of the instructions for the treatment of CRMI. In the course of the study, it was found that the proposed model of CRMI contributes to the formation of the phenomenon of mutual burdening and, as a result, complicates both the radiation and mechanical components of the lesion occurs.Conclusion The proposed experimental model for the application of severe CRMI helps to explore DCS tactics in the treatment of this pathology. DCS is a promising method of surgical treatment of CRMI, however, for more accurate extrapolation of data from animal to human, additional research on large laboratory animals is required.

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