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Damage Control Orthopaedics

Damage control orthopaedics (DCO) is an approach that aims to stabilize orthopaedic injuries early to avoid worsening a patient's physiology from a major surgery, while allowing time for the patient to stabilize before definitive fixation. The goals of DCO are to minimize the effects of a "second hit" from surgery, provisionally stabilize fractures to control bleeding, and allow time to optimize the patient's condition before definitive fixation. DCO involves initial hemorrhage control and temporary fracture stabilization, intensive care monitoring, and later staged definitive fracture repair once the patient's physiology has improved.

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Patrick Lukito
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92 views

Damage Control Orthopaedics

Damage control orthopaedics (DCO) is an approach that aims to stabilize orthopaedic injuries early to avoid worsening a patient's physiology from a major surgery, while allowing time for the patient to stabilize before definitive fixation. The goals of DCO are to minimize the effects of a "second hit" from surgery, provisionally stabilize fractures to control bleeding, and allow time to optimize the patient's condition before definitive fixation. DCO involves initial hemorrhage control and temporary fracture stabilization, intensive care monitoring, and later staged definitive fracture repair once the patient's physiology has improved.

Uploaded by

Patrick Lukito
Copyright
© © All Rights Reserved
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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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

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