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, and achievement of provisional fracture stability, while avoiding additional insults to the patient.

Many orthopaedic patients who have sustained multiple injuries benefit from the early total care of major bone fractures. However, the strategy is not the best option, and indeed might be harmful, for some multiply injured patients. Since foregoing all early surgery is not the optimal approach for those patients, the concept of damage control orthopaedics has evolved. Damage control orthopaedics emphasizes the stabilization and control of the injury, often with use of spanning external fixation, rather than immediate fracture repair. The concept of damage control orthopaedics is not new; it has evolved out of the rich history of fracture care and abdominal surgery. This article traces the roots of damage control orthopaedics, reviews the physiologic basis for it, describes the subgroups of patients and injury complexes that are best treated with damage control orthopaedics, reports the early clinical results, and provides a rationale for modern fracture care for the multiply injured patient.