Indications and interventions of damage control orthopedic surgeries: an expert opinion survey

Roman Pfeifer; Yannik Kalbas; Raul Coimbra; Luke Leenen; Radko Komadina; Frank Hildebrand; Sascha Halvachizadeh; Meraj Akhtar; Ruben Peralta; Luka Fattori; Diego Mariani; Rebecca Maria Hasler; Rolf Lefering; Ingo Marzi; François Pitance; Georg Osterhoff; Gershon Volpin; Yoram Weil; Klaus Wendt; Hans-Christoph Pape

doi:10.1007/s00068-020-01386-1

Indications and interventions of damage control orthopedic surgeries: an expert opinion survey

Eur J Trauma Emerg Surg. 2021 Dec;47(6):2081-2092. doi: 10.1007/s00068-020-01386-1. Epub 2020 May 26.

Authors

Roman Pfeifer¹, Yannik Kalbas², Raul Coimbra³, Luke Leenen⁴, Radko Komadina⁵, Frank Hildebrand⁶, Sascha Halvachizadeh², Meraj Akhtar², Ruben Peralta⁷, Luka Fattori⁸, Diego Mariani⁹, Rebecca Maria Hasler², Rolf Lefering¹⁰, Ingo Marzi¹¹, François Pitance¹², Georg Osterhoff¹³, Gershon Volpin¹⁴, Yoram Weil¹⁵, Klaus Wendt¹⁶, Hans-Christoph Pape²

Affiliations

¹ Department of Trauma, University of Zurich, UniversitätsSpital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland. Roman.Pfeifer@usz.ch.
² Department of Trauma, University of Zurich, UniversitätsSpital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
³ Riverside University Health System and Loma Linda University, Riverside, CA, USA.
⁴ Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
⁵ Department of Traumatology, General and Teaching Hospital Celje, Medical Faculty Ljubljana University, 3000, Celje, Slovenia.
⁶ Department of Trauma, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
⁷ Surgical Department (Hamad General Hospital), Hamad Medical Corporation, HMC, Doha, Qatar.
⁸ Department of Surgery, San Gerardo Hospital, University of Milan Bicocca, G.B. Pergolesi 33, Monza, Italy.
⁹ Department of Emergency General Surgery, Legnano Hospital, ASST Ovest Milanese, Legnano, MI, Italy.
¹⁰ IFOM, Institute for Research in Operative Medicine, Faculty of Health, University Witten/Herdecke, Ostmerheimer Straße 200, 51109, Cologne, Germany.
¹¹ Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany.
¹² Anesthesiology and Intensive Care Unit, CHR De La Citadelle, Liege, Belgium.
¹³ Department of Orthopaedics, Trauma, and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany.
¹⁴ Department of Orthopedic Surgery, EMMS Hospital, Nazareth, Affiliated to Galilee Medical Faculty Zfat, Bar Ilan University, Ramat Gan, Israel.
¹⁵ Orthopaedic Trauma Unit, Hadassah Hebrew University Hospital, Jerusalem, Israel.
¹⁶ Department of Trauma Surgery, University Medical Center Groningen (UMCG), Hanzeplein 1, 9700 RB, Groningen, The Netherlands.

PMID: 32458046
DOI: 10.1007/s00068-020-01386-1

Abstract

Objectives: The objectives of this study were to gather an expert opinion survey and to evaluate the suitability of summarized indications and interventions for DCO.

Background: The indications to perform temporary surgery in musculoskeletal injuries may vary during the hospitalization and have not been defined. We performed a literature review and an expert opinion survey about the indications for damage control orthopaedics (DCO).

Methods: Part I: A literature review was performed on the basis of the PubMed library search. Publications were screened for damage control interventions in the following anatomic regions: "Spine", "Pelvis", "Extremities" and "Soft Tissues". A standardized questionnaire was developed including a list of damage control interventions and associated indications. Part II: Development of the expert opinion survey: experienced trauma and orthopaedic surgeons participated in the consensus process.

Results: Part I: A total of 646 references were obtained on the basis of the MeSH terms search. 74 manuscripts were included. Part II: Twelve experts in the field of polytrauma management met at three consensus meetings. We identified 12 interventions and 79 indications for DCO. In spinal trauma, percutaneous interventions were determined beneficial. Traction was considered harmful. For isolated injuries, a new terminology should be used: "MusculoSkeletal Temporary Surgery".

Conclusion: This review demonstrates a detailed description of the management consensus for abbreviated musculoskeletal surgeries. It was consented that early fixation is crucial for all major fractures, and certain indications for DCO were dropped. Authors propose a distinct terminology to separate local (MuST surgery) versus systemic (polytrauma: DCO) scenarios.

Keywords: Damage control surgery; Extremity; Indication; Intervention; MuST surgery; Polytrauma; Soft tissues.

Publication types

Review

MeSH terms

Expert Testimony
Fractures, Bone* / surgery
Humans
Multiple Trauma* / surgery
Orthopedic Procedures*
Surveys and Questionnaires