The evolution and impact of the "damage control orthopedics" paradigm in combat surgery: a review

Eur J Orthop Surg Traumatol. 2019 Apr;29(3):501-508. doi: 10.1007/s00590-018-2320-x. Epub 2018 Oct 13.

Abstract

The idea of damage control (DC) is grounded on a sequential therapeutic strategy that supports physiological restoration over anatomic repair in critically injured patients. This concept is firstly described as damage control surgery (DCS) for war-wounded patients with abdominal exsanguinating trauma. The goal was to avoid prolonged operative times and prevent the outset of the lethal cycle of hypothermia, acidosis and coagulopathy. Damage control orthopedics (DCO) is also based on this concept and it is applied in the treatment of some polytrauma patients with pelvic and long bones fractures as to avoid the "second hit" of a lengthy definitive operation and eliminate initial morbidity and mortality. It is in favor of primary fracture stabilization utilizing provisional external fixation. When the patient is in stable condition, conversion to definitive open reduction and intramedullary nailing can be done. This stepwise approach should be considered as a part of the resuscitation process, and it follows the saying "do no further harm".

Keywords: Damage control orthopedics; Damage control surgery; Trauma; War.

Publication types

  • Review

MeSH terms

  • Acidosis / prevention & control
  • Blood Coagulation Disorders / prevention & control
  • Fractures, Bone / surgery*
  • Humans
  • Hypothermia / prevention & control
  • Multiple Trauma / complications
  • Multiple Trauma / physiopathology
  • Multiple Trauma / surgery*
  • Orthopedic Procedures / methods*
  • War-Related Injuries / complications
  • War-Related Injuries / physiopathology
  • War-Related Injuries / surgery*