Evidence brief
Damage Control Orthopaedics: Evolving Concepts in the Treatment of Patients Who Have Sustained Orthopaedic Trauma
Introduced 'damage control orthopaedics' concept for polytrauma
Temporary external fixation to minimize second hit phenomenon
Definitive fixation delayed until patient physiology stabilized
Based on understanding of systemic inflammatory response
Contrasted with 'early total care' in stable patients
DCO changed polytrauma management by recognizing that early definitive surgery can cause a 'second hit' in unstable patients. Temporary stabilization with external fixation allows resuscitation before definitive management.
Classic viva topic: 'Patient with bilateral femur fractures and chest injury - how do you manage?' Discuss DCO vs ETC. Know the physiological triggers (lactate >2.5, pH <7.25, temperature <35°C, coagulopathy) that favor DCO over ETC.
Pape HC, Giannoudis P, Krettek C. Damage control orthopaedics: evolving concepts in the treatment of patients who have sustained orthopaedic trauma. Instr Course Lect. 2002;51:289-303.
Level V
Expert opinion or mechanism-based reasoning