The timing of fracture treatment in polytrauma patients: relevance of damage control orthopedic surgery.

Abstract:

:Information illustrating the benefits of fracture stabilization after multiple trauma has been gathering for almost a century. At the turn of the last century, the introduction of the Thomas splint clearly demonstrated the importance of skeletal stabilization in the management of these patients. The introduction of standardized surgical treatment for fractures in the early 1950s is considered today as the turning point in the care of the polytraumatized patient. With the knowledge acquired, the application of early operative fixation of fractures in severely injured patients in the 1980s has yielded to the concept of early total care of all fractures. Yet, in distinct patient subgroups with severe thoracic injuries and very high injury severity scores, this concept has been associated with adverse outcomes. Therefore, in a further era that began in the 1990s, a different approach has been favored for these subgroups. It recommends early (initial) temporary stabilization followed by secondary definitive osteosynthesis of major fractures in patients at high risk of developing systemic complications. In the last decade, attempts have been made to determine which patients benefit from early total care and which ones should undergo a secondary definitive approach. This manuscript provides a historical overview on the changing treatment of fractures and summarizes the evolution of "damage control orthopedic surgery."

journal_name

Am J Surg

authors

Pape HC,Giannoudis P,Krettek C

doi

10.1016/s0002-9610(02)00865-6

subject

Has Abstract

pub_date

2002-06-01 00:00:00

pages

622-9

issue

6

eissn

0002-9610

issn

1879-1883

pii

S0002961002008656

journal_volume

183

pub_type

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