Damage Control

Orthopaedics

 Damage control orthopaedics is an approach

that contains and stabilizes orthopaedic injuries
so that the patient's overall physiology can
improve.
Its purpose is to avoid worsening of the
patient's condition by the second hit of a
major orthopaedic procedure and to delay
definitive fracture repair until a time when the
overall condition of the patient is optimized.
Minimally invasive surgical techniques such as
external fixation are used initially.

 Damage control focuses on:

control of hemorrhage
management of soft-tissue injury
achievement of provisional fracture
stability

Avoid worsening the patients injuries

Physiology of Damage Control

Orthopaedics
Traumatic injury
leads to systemic
inflammation
(systemic
inflammatory
response
syndrome)
followed by a
period of recovery
mediated by a
counter-regulatory
anti-inflammatory
response

 The key players in the host response appear to be the

cytokines, the leukocytes, the endothelium, Reactive
oxygen species, and microcirculatory disturbances.
When the initial massive injury and shock give rise to
an intense systemic inflammatory syndrome with the
potential to cause remote organ injury, this one hit
can cause an excessive inflammatory response that
activates the innate immune system, including
macrophages, leukocytes, natural killer cells, and
inflammatory cell migration enhanced by interleukin8 (IL-8) production and complement components (C5a
and C3a).

The First and Second-Hit

Phenomena
Numerous studies have
demonstrated that stimulation of
a variety of inflammatory
mediators takes place in the
immediate aftermath of trauma.
This response initially corresponds
to the first-hit phenomenon.
In this concept of the bodys
response to trauma, there is an
immediate inflammatory
response, and a second insult
causes a second, cumulative
inflammatory response. The
combined levels of inflammatory
mediators are then high enough
to cause generalized tissue
damage and can lead to multisystem organ failure

Clinical Parameters Used in

Hannover, Germany, to Define the
Borderline Patient for Whom
Damage Control Orthopaedics