Il timing nella gestione del polifratturato: l’anestesista e l’ortopedico

Abstract

The treatment of polyfractured patients has been largely reconsidered in the last decades. The main issue for debate has been if an immediate definitive treatment (Early Total Care, ETC) is always indicated or if a staged, minimally invasive approach (Damage Control Orthopaedics, DCO) should be preferred. The current approach is that the orthopaedic surgeon and the anaesthesiologist should carefully evaluate and classify the patient into one of four categories (stable, borderline, unstable, in extremis) to tailor the approach on his/her clinical status. ETC should be preferred for the stable patient, while DCO is the preferred approach in unstable and in extremis patients. The general status of borderline patients should be continuously reassessed, even during surgery. In uncertain cases, DCO should be preferred considering the potential reduction of surgical time, bleeding and inflammatory response.