Patient Selection: Orthopedic Approach in Polytrauma

  • Hans-Christoph Pape
  • Christopher C. Tzioupis
  • Peter V. Giannoudis

The development of the “two hit” theory has been helpful in understanding why certain patients may deteriorate unexpectedly after a major trauma and subsequent major surgery [1, 2]. Both the type and the severity of injury, the rescue conditions, and the individual patient’s response are given facts at the time of patient’s admission, representing the “first hit” in a trauma patient [1]. The subsequent treatment and unexpected complications can modify the clinical course substantially [3, 4, 5, 6, 7]. Thus, during the hospital stay, volume replacement, ventilatory support, and the surgical strategy are important variables [8] that may be modified by the hospital physician and thus regulate the degree of the impact of the second hit [9].


Injury Severity Score Hemorrhagic Shock Damage Control Blunt Chest Trauma Revise Trauma Score 
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© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Hans-Christoph Pape
    • 1
  • Christopher C. Tzioupis
  • Peter V. Giannoudis
  1. 1.Department of Orthopaedic SurgeryUniversity of PittsburghPittsburghUSA

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