Damage control orthopaedics in polytraumatized patients- current concepts |
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Authors: | Gershon Volpin Roman Pfeifer Jordan Saveski Ilir Hasani Miri Cohen Hans-Christoph Pape |
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Affiliation: | aGalilee Medical Faculty Zfat, Bar-Ilan University, Ramat Gan, Israel;bThe Center for Rehabilitation Research, University of Haifa, Israel;cDepartment for Traumatology, University Hospital Zurich, Switzerland;dUniversity Clinic for Traumatology, Medical Faculty, Skopje, Macedonia;eSchool of Social Work and the Center for Rehabilitation Research, University of Haifa, Israel |
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Abstract: | The principles of fracture management in patients with multiple injuries continue to be of crucial importance. Early treatment of unstable polytraumatized patients with head, chest, abdomen or pelvic injuries, with blood loss followed by immediate fracture fixation (Early Total Care -ETC) may be associated with secondary life threatening posttraumatic systemic inflammatory response syndrome (SIRS). Development of SIRS is typically a function of the type and severity of the initial injury (the “first hit”). Immediate Fracture fixation, using reamed nails or plates, in such unstable patients with multiple injuries is subsequently defined as the “second hit” and may be associated with development of acute respiratory distress syndrome (ARDS) and multiple organ failure (MOF), with relatively high morbidity and mortality.The other alternative for long bone fracture fixation in unstable polytraumatized patients is based on immediate treatment of life threatening conditions related to the injuries, followed by the initial use of minimally invasive modular external frames for long bone fractures and is called Damage Control Orthopedics (DCO) and is widely accepted. In order to refine the DCO concept and to avoid an overuse of external fixation, the “Safe Definitive Surgery” (SDS) concept has been introduced, which is a dynamic synthesis of both strategies (ETC and DCO). The SDS strategy employs clinical parameters and includes repeated assessment of patients. The following paper is going to summarize historical backgrounds and recent concepts in treatment of polytraumatized patients. |
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Keywords: | Polytrauma Multiple fractures Early total care (ETC) Damage control orthopaedics (DCO) Safe definitive treatment ARDS MOF |
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