Damage Control Orthopedics

Evidence-Based Orthopedics, pp. 423–430

Abstract

This chapter presents a case scenario of a multiply injured 45-year-old male patient in the trauma bay. The patient has severe major fractures that need stabilization: pelvic-ring fracture, femoral shaft fracture, Gustilo–Anderson Grade 3 open ankle fracture. Around the turn of the century, damage control orthopedics (DCO) was introduced to the care of the severely injured patient. DCO implies further surgical interventions to perform the definitive fixation and prolonged hospitalization with their associated increased risks of complications and adverse events. Pelvic fractures and femoral shaft fractures are associated with increased blood loss and hemorrhage and should be treated expeditiously. The external fixator usually is used during DCO as a temporary, minimal-invasive technique to stabilize a fracture. Early fracture treatment in severely injured patients should stop hemodynamic relevant bleeding, and decrease mid-term and long-term complications. The chapter also provides recommendations for implementing evidence-based practice in the clinical setting.

Authors 5

1. Sascha Halvachizadeh

   University of Zurich · University Hospital Zurich

   Affiliation as printed

   University of Zurich, Universitätsspital Zurich, Department of Trauma, Zurich, Switzerland

   University of Zurich, Universitätsspital Zurich, Research Laboratory, Division of Surgery and Harald Tscherne Laboratory, Zurich, Switzerland

   University of Zurich, Universitätsspital Zurich, Department of Trauma, Zurich, Switzerland

   University of Zurich, Universitätsspital Zurich, Research Laboratory, Division of Surgery and Harald Tscherne Laboratory, Zurich, Switzerland

2. Paolo Cinelli

   University of Zurich · University Hospital Zurich

   Affiliation as printed

   University of Zurich, Universitätsspital Zurich, Research Laboratory, Division of Surgery and Harald Tscherne Laboratory, Zurich, Switzerland

   University of Zurich, Universitätsspital Zurich, Research Laboratory, Division of Surgery and Harald Tscherne Laboratory, Zurich, Switzerland

3. Florin Allemann

   University of Zurich · University Hospital Zurich

   Affiliation as printed

   University of Zurich, Universitätsspital Zurich, Department of Trauma, Zurich, Switzerland

   University of Zurich, Universitätsspital Zurich, Department of Trauma, Zurich, Switzerland

4. Philipp Kobbe Aachen Department of Orthopaedic Trauma

   Universitätsklinikum Aachen

   Affiliation as printed

   Aachen University Medical Center, Department of Orthopaedic Trauma, Aachen, Germany

5. Hans‐Christoph Pap

   University of Zurich · University Hospital Zurich

   Affiliation as printed

   University of Zurich, Universitätsspital Zurich, Department of Trauma, Zurich, Switzerland

   University of Zurich, Universitätsspital Zurich, Department of Trauma, Zurich, Switzerland