DAMAGE CONTROL ORTHOPAEDIC

Rio Aditya, dr.,

Department of Orthopaedics & Traumatology – Faculty of Medicine
Universitas Padjadjaran
 INTRODUCTION

Early 70’s Prolonged immobilization (Traction, bed

rest). Increased incidence of PE, DVT, muscle
wasting, decubitus ulcers

ETC  decreased LOS, less pulmonary Fakhry et al,

Bone et al
complications, quicker mobilization Rogers et al
≤96 h/ 24-72 h
delay  decreased
DCO OR time, LOS,
decreased mortality
 DEFINITION
DCO: approach that contains and stabilizes orthopaedic injuries so that the
patient’s overall physiology can improve.

To avoid “second hit” of a major orthopaedic procedure and to delay

definitive fracture repair.

Control of hemorrhage, management of soft-tissue injury and achievement

of provisional fracture stability.
Physiology of DCO
A hyperinflammatory early phase may be followed by a
hypoinflammatory phase, which often precedes the onset
of organ failure.

The magnitude of the inflammatory response depends on

the degree of trauma, and it can be influenced by
treatment.

Waiting several days before performing surgery in

multitrauma patients eradicates the danger of this
detrimental immunologic response.
 GOALS OF DCO
• MINIMIZE EFFECTS OF SECOND HIT
• EARLY, PROVISIONAL FRACTURE STABILIZATION
• CONTROL HEMORRHAGE/ STABILIZE FRACTURE
HEMATOMA
• TIME TO OPTIMIZE THE PATIENT
• EARLY PATIENT MOBILIZATION[
PHASES OF DCO

• Phase 1 ( Acute) : life-saving procedures

• Phase 2 : Hemorrhage control, fracture stabilization, manage soft
tissue injury
• Phase 3 : ICU monitoring
• Phase 4 : definitive fracture fixation

Shapiro et. Al, J Trauma 2000

 TRAUMA SCORING SYSTEM
 Based on anatomic criteria; defines injury severity
• Injury Severity Scale (ISS)
for comparative purposes
• Abbreviated Injury Scale (AIS)  Based on scores of 9 anatomic regions:
1. Head
2. Face
3. Neck
4. Thorax
5. Abdominal and pelvic contents
6. Spine
7. Upper extremity
8. Lower extremity
9. external
 TRAUMA SCORING SYSTEM
• Injury Severity Scale (ISS)
• Abbreviated Injury Scale (AIS)
What is the Injury Severity Score (ISS) for a patient with
an open chest wound (Abbreviated Injury Scale, AIS=4),
colon transection (AIS=4), femoral fracture (AIS=3),
shoulder dislocation (AIS=2), and a thyroid gland
contusion (AIS=1)

ISS: 16 + 16 + 9
ISS: 41
DAMAGE CONTROL ORTHOPAEDIC
DAMAGE CONTROL ORTHOPAEDIC
 DAMAGE CONTROL ORTHOPAEDIC
Damage control surgery is indicated in 10-20% of polytrauma patients
DCO can be used in two circumstances:
1. Reactively: “bail-out” surgery
2. Preemptively

3 different conditions for selecting DCS:

1. Physiological criteria
2. Complex pattern of severe injuries
3. Mass casualities
 DAMAGE CONTROL PROCEDURES

• Control of hemorrhage: by ligation or packing

• Splinting of long-bone and pelvic fractures (with ex-fix or splints)
• Reducing the risk of infection by fecal diversion, irrigation and wound
debridement
• After physiological restoration in the ICU, staged definitive surgery can take
place under planned and controlled circumstances
TIMING OF SURGICAL INTERVENTION IN
POLYTRAUMA PATIENT
DAMAGE CONTROL ORTHOPAEDIC
THANK YOU