The evolution and impact of the “damage control orthopedics” paradigm in combat surgery: a review

  • Georgios KalinterakisEmail author
  • Antonios Koutras
  • Athanasios Syllaios
  • Nikolaos Michalakeas
  • Dimitrios Lytras
  • Ioannis Tsilikis


The idea of damage control (DC) is grounded on a sequential therapeutic strategy that supports physiological restoration over anatomic repair in critically injured patients. This concept is firstly described as damage control surgery (DCS) for war-wounded patients with abdominal exsanguinating trauma. The goal was to avoid prolonged operative times and prevent the outset of the lethal cycle of hypothermia, acidosis and coagulopathy. Damage control orthopedics (DCO) is also based on this concept and it is applied in the treatment of some polytrauma patients with pelvic and long bones fractures as to avoid the “second hit” of a lengthy definitive operation and eliminate initial morbidity and mortality. It is in favor of primary fracture stabilization utilizing provisional external fixation. When the patient is in stable condition, conversion to definitive open reduction and intramedullary nailing can be done. This stepwise approach should be considered as a part of the resuscitation process, and it follows the saying “do no further harm”.


Damage control surgery Trauma Damage control orthopedics War 


Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  • Georgios Kalinterakis
    • 1
    Email author
  • Antonios Koutras
    • 2
  • Athanasios Syllaios
    • 3
  • Nikolaos Michalakeas
    • 4
  • Dimitrios Lytras
    • 5
  • Ioannis Tsilikis
    • 6
  1. 1.Department of Orthopedics401 General Military HospitalAthensGreece
  2. 2.Department of Obstetrics and GynecologyLaiko University Hospital of AthensAthensGreece
  3. 3.1st Department of SurgeryLaiko University Hospital of AthensAthensGreece
  4. 4.Department of PathologyGeneral Hospital of KalamataKalamataGreece
  5. 5.Department of OrthopedicsGeneral Hospital of KarditsaKarditsaGreece
  6. 6.Department of Ιnterventional Radiology and Neuroradiology-Interventional CardiologyEuroclinicAthensGreece

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