2. Introduction
• Damaged control orthopaedics is basically when the definitive
management is delayed until the physiology or condition of the patient
improves.
• Early total care is basically early stabilisation of the skeletal injuries in all
age groups irrespective of the injury severity.
• Term damaged control coined by US navy(Capacity of the ship to absorb
damage.)
• Rotondo 1st used damage control surgery for patients with penetrating
trauma.
3. • Based on the concepts of damage control surgery the application of
the same principles in orthopaedics is damage control orthopaedics.
• It is a basic step wise approach or management in a staged manner
for multiple injured patients.
• The initial goal is to perform the least morbid procedure to preserve
life and prevent death and later fix.
4. Stages of damage control surgery
• 1)Stage 1 Stop the damage-Early temporary stabilisation of the
fracture(Generally fixator) and haemorrhage control
• 2)Stage2-Stabilise physiology-Resustication and patient optimisation
• 3)Stage3-Definitive stabilisation-Definitive fixation of the underlying
fracture.
5. • Stage1–
• A patient comes with a compound tibia grade 3b fracture to the casualty
with a head trauma.
• First we will enquire about the history of the head trauma,whether it was
associated with loss of consciousness or not.
• Investigate it by doing a CT of the brain and keep the patient in observation
for a period of 24 hours.
• Simultaneously we give a thorough wound wash,remove all debris and
immobilise patient in a slab and admit the patient to be observed for one
day.
6. • Once the patient is stable the next day we take the patient inside the Ot for
wound debridement and fixator application as a mean to temporarily
stabilise the fracture and give the patient post operative antibiotics and
pain killers and optimise his condition.
• Stage 2-Control the haemorrhage,Give him fluids,Monitor the patients
vitals and optimise the status of the patient for definitive fixation.
• Stage 3-After doing the necessary work up we plan for definitive fixation
that is the fracture temporarily stabilised by external fixator should be
converted into nailing procedure and post operatively once the patient is
stable the patient can be discharged.
9. Indications of damaged control orthopaedics
• 1)Underlying head injury
• 2)Cardiac ischaemia
• 3)GCs<8
• 4)Injury severity score more than 40 without trauma
• 5)ISS more than 20 with trauma
• 6)Polytrauma
• 7)Hypothermia Less than 35 degrees
• 8)Interleukin more than 500pg/dl
