Abstract
• Emergent definitive care of orthopaedic injuries in critical patients may not be the best strategy. • Critically injured patients not in the operating room for life-saving procedures should be physiologically stable prior to major surgical procedures. • Patients with closed head injuries must maintain optimal parameters for best recovery. • Damage control orthopaedic surgery (DCO) is the most controversial and least understood concept in modern trauma surgery. • A damage control approach to fracture care in the multiple trauma patient has merit. • Literature (mostly retrospective and single center) is weak and can be interpreted as desired. – Early major fracture care may be beneficial 1 Need to define early 2 Need to define fracture fixation • Surgery is performed to improve the physiology of the patient. • External fixation and delayed definitive fixation for patients in the operating room. • Bedside application of external fixation or traction until the patient is physiologically stable for definitive care in patients not in need of life-saving surgery. • Develop a “Risk Adjusted” orthopaedic surgery strategy for each patient.
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