June 1, 2017

Fig 1. Polytrauma caused by a fall – The Hughston Foundation, Inc. ©2017

Surgeons use damage control orthopedics (DCO) to manage critically injured patients by temporarily stabilizing fractures so that the patient’s overall condition can improve. The purpose is to avoid worsening the patient’s condition by the “second hit” of a major orthopedic procedure. The surgeon’s strategy focuses on controlling bleeding, managing soft-tissue injury, and fracture stability while avoiding additional trauma to the patient.

When a person is injured, particularly a polytrauma patient where multiple bones are broken and internal organs are damaged, the body responds by releasing inflammatory mediators (fluids, including blood and cells that are meant to heal and protect) (Fig. 1). As a result of the injury, the trauma patient also experiences detrimental physiological changes, such as extensive blood loss that leads to decreased tissue oxygenation (blood cells carry oxygen to tissue), and large amounts of blood replacement that can cause abnormalities in clotting. The patient can also be affected by Acute Respiratory Distress Syndrome (ARDS), a condition caused by fluids leaking into the lungs and reducing oxygen. Furthermore, the patient becomes susceptible to infection and can become septic (an infection within the bloodstream). Finally, these factors often affect the trauma patient in a short period of time, and this serious combination can lead to multiple organ failure and death.