DAMAGE CONTROL IN ORTHOPEDICS

Saša Jovanović; Predrag Denović

doi:10.35120/medisij020307j

Authors

Saša Jovanović CHC Kosovska Mitrovica, Department of Orthopedic Surgery and Traumatology, Serbia
Predrag Denović CHC Kosovska Mitrovica, Department of Orthopedic Surgery and Traumatology, Serbia

DOI:

https://doi.org/10.35120/medisij020307j

Keywords:

damage, control, polytrauma, orthopedics

Abstract

Introduction: DAMAGE CONTROL - in orthopedic surgery and traumatology, it is indicated for fresh fractures, especially for trauma with open bone fractures. In all these fresh fractures, hemodynamic instability of the body occurs. In these cases, a minimally invasive procedure is recommended, which initially aims to temporarily stabilize the fractures and control bleeding
Material and methods: In our work, we will present the official literature that deals with the issue of damage control in orthopedics.
Discussion: One of the leading causes of death in people under 40 is polytrauma. Fractures of the diaphysis of the tibia, femur, and pelvis are the most common fractures that are stabilized using external fixation. Bilateral fractures of the femoral diaphysis are associated with a poor prognosis in terms of mortality and fat embolism syndrome.Hemodynamically stable patients should always undergo definitive fracture fixation. Any prolonged intervention in hemodynamically unstable patients worsens the favorable outcome. Then the immune response can be triggered and increased, which is identified with the clinical condition “Second trauma”. Therefore, these patients should be immediately subjected to DAMAGE CONTROL with temporary stabilization and then delayed definitive fixation for a period of 5-10 days from damage control, i.e. in the second act. Orthopedic surgeons should be very careful and recognize the triangle of death - acidosis, hypothermia and coagulopathy, which are interconnected and eventually become irreversible and lead to death as the final outcome. Damage control surgery in orthopedics includes three stages: the first stage of treatment involves controlling bleeding, reducing contamination, and achieving temporary fracture fixation. The time in which all this is done should be as short as 1-2 hours. The second phase involves the stabilization of vital parameters in the ICU as well as the reanimation of the child with the prescription of the necessary therapy as well as blood replacement
The aim: The aim of our work is to demonstrate the outcome and feasibility of damage control in orthopedic surgery for both adults and children with multiple limb injuries and polytraumatized patients
Conclusion: Polytrauma is a condition of the body that requires immediate action and a special approach because the patient’s life is at risk in a high percentage. The principles used to manage patients with multiple injuries including head, lower leg. Early fracture fixation led to earlier mobilization of patients and thus And reduced the percentage of complications, wound infections as well as reducing treatment costs. DAMAGE CONTROL is not only used in traumatized adult patients. It is also necessary to do it in children’s patients.

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Author Biographies

Saša Jovanović, CHC Kosovska Mitrovica, Department of Orthopedic Surgery and Traumatology, Serbia

Predrag Denović, CHC Kosovska Mitrovica, Department of Orthopedic Surgery and Traumatology, Serbia

References

Božović, A., Таbaković D. (2021). Postupci sa otvorenim prelomima-Prelomi potkolenice. Univerzitet u Prištini sa privremenim sedištem u Kosovskoj Mitrovici. Medicinski fakultet. ISBN:978-86-81824-04-7

D’Alleyrand, J.,C.,G.,& O’Toole, R. V. (2013).The evolution of damage control orthopedics.Current evidence and practical applications of early appropriate care.OrthopClin North Am.;44:499-507. Doi: 10.1016/j.ocl.2013.06.004 DOI: https://doi.org/10.1016/j.ocl.2013.06.004

Vallier, H.,A., Wang X., Moore T.,A., Wilber, J.,H.,& Como J.,J. (2013). Timing of orthopaedic surgery in multiple trauma patients: Development of a protocol for early appropriate care. J Orthop Trauma.;27:543-51. Doi: 10.1097/ BOT.0b013e31829efda1. DOI: https://doi.org/10.1097/BOT.0b013e31829efda1

Božović, A., Таbaković D. (2021). Opšti postupci sa povredjenim kostima-Prelomi potkolenice. Univerzitet u Prištini sa privremenim sedištem u Kosovskoj Mitrovici. Medicinski fakultet. ISBN:978-86-81824-04-7 Roberts, C., Pape, C.,H., Jones, A., Malkani, A., Rodriguez,J., &Giannoudis, P. (2005).Damage control orthopaedics.Evolving concepts in the tratment of patients who have sustained orthopaedic trauma. J Bone Jt. Surg.;87- A:434-49. Doi: 10.1016/j.mpsur.2015.03.003. DOI: https://doi.org/10.2106/00004623-200502000-00030

Baker, S.& O`Neill, B. (1976).The injury serverityscore: An update. J Trauma.; 16(11):882 doi:10.1097/00005373- 197611000-00006. . DOI: https://doi.org/10.1097/00005373-197611000-00006

Božović,. A, Grbić, R., Milović, D., Elek, Z., Petrović, D., Jakšić,Lj,,&Radojević, G.Treatment of tibial shaft fractures with Mitkovic type external fixation-analysis of 100 patients.Srp.Arh.Celok. Lek. 2017 Nov-Dec; 145(11-12): 605-610. doi 102298/SARH161206137B.2017 god.--- DOI: https://doi.org/10.2298/SARH161206137B

Wong, T.,H., Krishnaswamy, G., Nadkarni, N.,V., Nguyen, H. V., Lim, G.,H., Bautista, D.,C.,T., & al. (2016) Combining the new injury severity score with an anatomical polytrauma injury variablepredicts mortality better than the new injury severity score and the injury severity score:A retrospective cohort study. Scand J Trauma Resusc Emerg Med.; 24: 1-11. Doi: 10.1186/s13049-016-0215-6. DOI: https://doi.org/10.1186/s13049-016-0215-6

Deng, Q., Tang, B., Xue, C., Liu, Y., Liu, X,,Lv, Y., & al. (2016). Comparison of the ability to predictmortality between the injury severity score and the new injury severity score: A meta- analysis. Int J Environ Res Public Health. 2016;13:1-12. Doi: 10.3390/ijerph13080825. DOI: https://doi.org/10.3390/ijerph13080825

Waydhas, C., Nast-Kolb, D., Trupka, A., @Settl, R. (1996).Posstraumatic inflammatory response,secondary operations, and late multiple organ failure.J Trauma.40:624-31. DOI: https://doi.org/10.1097/00005373-199604000-00018

Martinez, R., A., Uribe, J., P., Escobar, S., S., Henao, J., Rios, J.,A.,& Martinez-Cano, J., P. (2018) Control de dañoy estabilización temprana definitiva en el tratamiento del paciente politraumatizado;32(3):152-60. DOI: 10.1016/j. rccot.2017.11.009 DOI: https://doi.org/10.1016/j.rccot.2017.11.009

Nicola, R. (2013). Early total care versus damage control: current concepts in the orthopedic care of polytrauma patients. ISRN Orthop.:1-9. Doi: 10.1155/2013/329452. DOI: https://doi.org/10.1155/2013/329452

Божовић, А., Митковић, М., Грбић, Р., Васић, А., Јакшић, Љ., Петровић, Д., Радојевић, Г., Миловић, Д., & Аџић В. (2013). Стабилност и квалитет остеосинтезе у лечењу прелома пилона тибије методом динамичке спољашње фиксације по Митковићу. Acta chirurgica iugoslavica,; 60(2): 93-98--

Peden, R., McGee, K., Krug, E.,&Peden, M.,M. (2002).World Health Organization.Injuries and violence prevention department.injury : a leading cause of the global burden of disease 2000. World Health Organization.

Schell, H., Duda, G.,N., Peters, A., Tsitsilonis, S., Johnson, K., A.,&Schmidt-Bleek, K. (2017). The haematomaand its role in bone healing. J Exp Orthop.;4:5. Doi: 10.1186/s40634-017-0079-3.

Horst, K., Eschbach, D., Pfeifer, R., Hübenthal, S., Sassen, M., Steinfeldt, T., & al. (2015).Local Inflammation in Fracture Hematoma: Results from a Combined Trauma Model in Pigs. Mediators Inflamm.Doi: 10.1155/2015/126060.

Pape, H.,C., Lefering, R., Butcher, N., Peitzman, A., Leenen, L., Marzi, I., & al. (2014).The definition of polytraumarevisited: An international consensus process and proposal of the new “Berlin definition.” J Trauma Acute Care Surg.;77:780-6. Doi: 10.1097/TA.0000000000000453. DOI: https://doi.org/10.1097/TA.0000000000000453

Copeland, C., Mitchell, K., Brumback, R., Gens, D., &Burgess, A. (1998).Mortality in patients withbilateral femoral fractures. J Orthop Res.;12:315-9. DOI: https://doi.org/10.1097/00005131-199806000-00003

Pape, H.,C., Rixen, D., Morley, J., Husebye, E.,E., Mueller, M., Dumont, C., & al. (2007).Impact of the method of initial stabilization for femoral shaft fractures in patients with multiple injuries at risk for complications (borderline patients). Ann Surg.;246:491-9. Doi: 10.1097/SLA.0b013e3181485750. DOI: https://doi.org/10.1097/SLA.0b013e3181485750

Giannoudis, P.,V., Hildebrand, F.,&Pape, H.,C. (2004).Inflammatory serum markers in patients withmultiple trauma. Can they predict outcome? J Bone JtSurgSer B.;86:313-23. Doi: 10.1302/0301- 620X.86B3.15035. DOI: https://doi.org/10.1302/0301-620X.86B3.15035

Giannoudis, P.,V., Smith, R.,M., Bellamy, M.,C., Morrison, J., F., Dickson, R.,A., &Guillou, P.,J. (1999).Stimulationof the inflammatory system by reamed and unreamed nailing of femoral fractures.An analysis of the second hit. J Bone JtSurgSer B.;81:356-61. Doi: 10.1302/0301- 620X.81B2.8988. DOI: https://doi.org/10.1302/0301-620X.81B2.0810356

Schell, H., Duda, G., N., Peters A., Tsitsilonis, S., Johnson, K., A., &Schmidt-Bleek, K. (2017). The haematomaand its role in bone healing. J Exp Orthop.;4:5. Doi: 10.1186/s40634-017-0079-3. DOI: https://doi.org/10.1186/s40634-017-0079-3

Giannoudis, P.,V. (2003). Surgical priorities in damage control in polytrauma. J Bone JtSurgSer B.;85:478-83. Doi: 10.1302/0301-620X.85B4.14217. DOI: https://doi.org/10.1302/0301-620X.85B4.14217

Kostenuik, P., &Mirza, F., M. (2017).Fracture healing physiology and the quest for therapies for delayed healing and nonunion. J Orthop Res.;35:213-23. Doi: 10.1002/jor.23460. DOI: https://doi.org/10.1002/jor.23460

Horst, K., Eschbach, D., Pfeifer, R., Hübenthal, S., Sassen, M., Steinfeldt, T., & al. (2015).Local Inflammation in Fracture Hematoma: Results from a Combined Trauma Model in Pigs. Mediators Inflamm.Doi: 10.1155/2015/126060. DOI: https://doi.org/10.1155/2015/126060

Nowotarski, P.,J., Turen, C.,H., Brumback, R.,J.,&Scarboro, J.,M. (2000).Conversion of external fixation to intramedullary nailing for fractures of the shaft of the femur in multiply injured patients. J Bone Joint SurgAm.;82:781-8. DOI: https://doi.org/10.2106/00004623-200006000-00004

Pfeifle, V.,A., Schreiner, S., Trachsel, D., Holland-Cunz, S., G., &Mayr, J. (2019). Damage control orthopedics applied in an 8-year-old child with life-threatening multiple injuries: A CARE-compliant case report. Medicine (Baltimore).Apr;98(16):e15294. doi: 10.1097/MD.0000000000015294. PMID: 31008978; PMCID: PMC6494245. DOI: https://doi.org/10.1097/MD.0000000000015294

Grbić, R., Božović, A., Samardžić, S., &Grbić, M. (2010). Kvalitet života pacijenata sa prelomima dijafize tibije operisanih spoljašnjim fiksatorom po Mitkoviću. Materia medica.;26(2):27-32.

Gandhi, R.,R., Overton, T.,L., Haut, E.,R., Lau, B., Vallier, H.,A., Rohs, T., &al. (2014).Optimal timing offemur fracture stabilization in polytrauma patients: A practice management guidelinefrom the Eastern Association for the Surgery of Trauma. J Acute Care Surg.;77:787-95. DOI: https://doi.org/10.1097/TA.0000000000000434

Грбић, Р. & Божовић А. (2010). Спољашња фиксација сложених прелома скочног зглоба.Praxis Medica; 38(1- 2): 147-149.

Volpin, G., Pfeifer, R., Saveski, J., Hasani, I., Cohen, M.,&Pape, H., C. (2021).Damage control orthopaedics in polytraumatized patients- current concepts. J ClinOrthop Trauma.Jan;12(1):72-82. doi: 10.1016/j.jcot.2020.10.018. Epub 2020 Nov 6. PMID:33716431; PMCID: PMC7920204. DOI: https://doi.org/10.1016/j.jcot.2020.10.018