Damage-control orthopedics: evolution and practical applications

Abstract

Evaluation and management of patients who sustain blunt trauma with multiple injuries have changed significantly over the past 50 years. Initially, clinical research supported delayed definitive treatment of the orthopedic subset of injuries in these patients. With the advancement of splinting and fixation techniques, this view changed to one of "early total care." Current developments in classifying trauma patients at risk for deterioration (objective scoring scales) and understanding the posttraumatic immune response have allowed us to stratify patients' clinical severity and treat appropriately. The damage-control philosophy proposes early stabilization, resuscitation, and delayed definitive treatment for polytrauma patients with orthopedic injuries who are most at risk.