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Damage Control Orthopedics in the Polytrauma Patient

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Abstract

Trauma continues to represent the major cause of death in patients under the age of 40. Especially road traffic injuries are the leading cause of death in high-income countries among young people aged 5–29 years [1]. The severity of consequent illness and the resulting disability is high compared with other disease processes [2, 3]. In 1998, about 5.8 million people died worldwide from accidental injuries [4]. In the United States, 12,400 people die each month following trauma [5]. Early mortality after severe trauma is either due to head trauma or exsanguination due to uncontrolled hemorrhage or late from multiple organ dysfunction syndrome (MODS). Once multiple systems are altered, the mortality rates may exceed 50%, the morbidity in survivors is severe, and the health care costs are enormous [2, 6].

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References

  1. Peden M, McGee K, Krug E, editors. Injury: a leading cause of the global burden of disease, 2000. Geneva: World Health Organization; 2002.

    Google Scholar 

  2. Holbrook TL, Anderson JP, Sieber WJ, Browner D, Hoyt DB. Outcome after major trauma: 12-month and 18-month follow-up results from the Trauma Recovery Project. J Trauma. 1999;46–5:765–71; discussion 71–3.

    Google Scholar 

  3. Gwinnutt CL, Driscoll PA, Whittaker J. Trauma systems – state of the art. Resuscitation. 2001;48–1:17–23.

    Google Scholar 

  4. Krug E. Injury: a leading cause of the global burden of disease. Geneva: World Health Organisation; 1999:WHO/HSC/P VI/99.11.

    Google Scholar 

  5. MacKenzie EJ, Fowler CJ. Epidemiology. In: Mattox KL, Feliciano DV, Moore EE, editors. Trauma 4th emergency department. New York: McGraw-Hill; 2000. p. 21.

    Google Scholar 

  6. Zhou Y, Baker TD, Rao K, Li G. Productivity losses from injury in China. Inj Prev. 2003;9–2:124–7.

    Google Scholar 

  7. Long WB, Bachulius BL, Hynes GD. Accuracy and relationship of mechanism of injury, trauma score and injury severity in identifying major trauma. Am J Surg. 1986;151:581–4.

    PubMed  CAS  Google Scholar 

  8. Bradford DS, Foster RR, Nossel HL. Coagulation alterations, hypoxemia, and fat embolism in fracture patients. J Trauma. 1970;10:307–21.

    PubMed  CAS  Google Scholar 

  9. Renne J, Wuthier R, House E, Cancro JC, Hoaglund FT. Fat macroglobulemia caused by fractures or total hip replacement. J Bone Joint Surg. 1978;60-A:613–8.

    Google Scholar 

  10. Henry BJ, Vrahas MS. The Thomas splint. Questionable boast of an indispensable tool. Am J Orthop (Belle Mead NJ). 1996;25(9):602–4.

    CAS  Google Scholar 

  11. Mueller ME, Allgower M, Schneider R, Willenegger H. Manual of osteosynthesis. Berlin, Heidelberg, New York: Springer; 1970.

    Google Scholar 

  12. Wickstrom J, Corban MS. Intramedullary fixation of fractures of the femoral shaft. J Trauma. 1967;7:551–83.

    PubMed  CAS  Google Scholar 

  13. Smith JEM. The results of early and delayed internal fixation of fractures of the shaft of the femur. J Bone Joint Surg. 1964;46B:28–32.

    Google Scholar 

  14. Riska EB, Bonsdorff Hvon, Hakkinen S, Jaroma H, Kiviluoto O, Paavilainen T. Primary operative fixation of long bone fractures in patients with multiple injuries. J Trauma. 1977;17:111–21.

    PubMed  CAS  Google Scholar 

  15. Goris RJ, Gimbrere JSF, Niekerk JLMvan, Shoots FJ, Booy LH. Early osteosynthesis and prophylactic mechanical ventilation in the multitrauma patient. J Trauma. 1982;22: 895–903.

    PubMed  CAS  Google Scholar 

  16. Talucci RC, Manning J, Lampard S. Early intramedullary nailing of femoral shaft fractures: a cause of fat embolism syndrome. Am J Surg. 1983;146:107–11.

    PubMed  CAS  Google Scholar 

  17. Seibel R, LaDuca J, Hassett JM, et al. Blunt multiple trauma (ISS 36), femur traction, and the pulmonary failure-septic state. Ann Surg. 1985;202:283–95.

    PubMed  CAS  Google Scholar 

  18. Bone LB, Johnson KD, Weigelt J, Scheinberg R. Early versus delayed stabilization of fractures. A prospective randomized study. J Bone Joint Surg. 1989;71A:336–40.

    Google Scholar 

  19. Johnson KD, Cadambi A, Seibert GB. Incidence of adult respiratory distress syndrome in patients with multiple musculoskeletal injuries: effect of early operative stabilization of fractures. J Trauma. 1985;25:375–84.

    PubMed  CAS  Google Scholar 

  20. Behrman SW, Fabian TC, Kudsk KA. Improved outcome with femur fractures: early vs delayed fixation. J Trauma. 1990;30:792–8.

    PubMed  CAS  Google Scholar 

  21. van Os JP, Roumen RMH, Schoots FJ, Heystraten FM, Goris RJ. Is early osteo-synthesis safe in multiple trauma patients with severe thoracic trauma and pulmonary contusion. J Trauma. 1994;36:495–9.

    PubMed  Google Scholar 

  22. Ecke H, Faupel L, Quoika P. Gedanken zum zeitpunkt der operation bei frakturen des oberschenkelknochens. Unfallchirurgie. 1985;11:89–93.

    PubMed  CAS  Google Scholar 

  23. Sturm JA, Wisner HD, Oestern HJ, Kant CJ, Tscherne H, Creutzig H. Increased lung capillary permeability after trauma: a prospective clinical study. J Trauma. 1986;26:409–15.

    PubMed  CAS  Google Scholar 

  24. Boulanger BR, Stephen D, Brennemann FD. Thoracic trauma and early intramedullary nailing of femur fractures: are we doing harm? J Trauma. 1997;43:24–9.

    PubMed  CAS  Google Scholar 

  25. Pape HC, Auf’m’Kolk M, Paffrath T, Regel G, Sturm JA, Tscherne H. Primary intramedullary femur fixation in multiple trauma patients with associated lung contusion: a cause of post-traumatic ARDS? J Trauma. 1993;34:540–8.

    PubMed  CAS  Google Scholar 

  26. Giannoudis PV, Abbott C, Stone M, Bellamy MC, Smith RM. Fatal systemic inflammatory response syndrome following early bilateral femoral nailing. Intensive Care Med. 1998;24:641–2.

    PubMed  CAS  Google Scholar 

  27. Giannoudis PV, Smith RM, Bellamy MC, Morrison JF, Dickson RA, Guillou PJ. Stimulation of the inflammatory system by reamed and unreamed nailing of femoral fractures: an analysis of the second hit. J Bone Joint Surg. 1999;81B:356–61.

    Google Scholar 

  28. Pape HC, Giannoudis P, Krettek C. The timing of fracture treatment in polytrauma patients: relevance of damage control orthopaedic surgery. Am J Surg. 2002;183:622–9.

    PubMed  Google Scholar 

  29. Smith RM, Giannoudis PV. Trauma and immune response. J R Soc Med. 1998;91:417–20.

    PubMed  CAS  Google Scholar 

  30. Giannoudis PV, Smith RM, Windsor AJ, Bellamy MC, Guillou PJ. Monocyte HLA-DR expression correlates with intrapulmonary shunting after major trauma. Am J Surg. 1999;177:454–9.

    PubMed  CAS  Google Scholar 

  31. Giannoudis PV, Smith RM, Windsor AJ, Perry SL, Dickson RA, Bellamy MC. Immediate IL-10 expression following major orthopaedic trauma: relationship to anti-inflammatory response and subsequent development of sepsis. Int Care Med. 2000;26:1076–81.

    CAS  Google Scholar 

  32. Menzel CL, Pfeifer R, Darwiche SS, Kobbe P, Gill R, Shapiro RA, et al. Models of lower extremity damage in mice: time course of organ damage and immune response. J Surg Res. 2011;166(2):e149–56.

    PubMed  Google Scholar 

  33. Bone RC. Toward a theory regarding the pathogenesis of the systemic inflammatory response syndrome: what we do and do not know about cytokine regulation. Crit Care Med. 1996;24:162–72.

    Google Scholar 

  34. Giannoudis PV, Smith RM, Banks RE, Windsor AR, Dickson RA, Guillou PJ. Stimulation of inflammatory markers after blunt trauma. Br J Surg. 1998;85:986–90.

    PubMed  CAS  Google Scholar 

  35. Giannoudis PV, Smith RM, Ramsden CW, Sharples D, Dickson RA, Guillou PJ. Molecular mediators and trauma: effects of accidental trauma on the production of plasma elastase, IL-6, sICAM-1 and sE-selectin. Injury. 1996;27:376–7.

    Google Scholar 

  36. Giannoudis PV, Pape HC. Damage control orthopaedics in unstable pelvic ring injuries. Injury. 2004;35(7):671–7.

    PubMed  CAS  Google Scholar 

  37. Scalea TM, Boswell SA, Scott JD, Mitchell KA, Kramer ME, Pollak AN. External fixation as a bridge to intramedullary nailing for patients with multiple injuries and with femur fractures: damage control orthopedics. J Trauma. 2000;48:613–21.

    PubMed  CAS  Google Scholar 

  38. Nowotarski PJ, Turen CH, Brumback RJ, Scarboro JM. Conversion of external fixation to intramedullary nailing for fractures of the shaft of the femur in multiply injured patients. J Bone Joint Surg Am. 2000;82:781–8.

    PubMed  CAS  Google Scholar 

  39. Pape HC, Hildebrand F, Pertschy S, Zelle B, Garapati R, Grimme K, et al. Changes in the management of femoral shaft fractures in polytrauma patients: from early total care to damage control orthopedic surgery. J Trauma. 2002;53(3):452–61.

    PubMed  Google Scholar 

  40. Meregalli A, Oliveira RP, Friedman G. Occult hypoperfusion is associated with increased mortality in hemodynamically stable, high risk, surgical patients. Crit Care. 2004;8–2:R60–5.

    Google Scholar 

  41. Tilney NL, Bailey GL, Morgan AP. Sequential system failure after rupture of abdominal aortic aneurysms: an unsolved problem in postoperative care. Ann Surg. 1973;178:117–22.

    PubMed  CAS  Google Scholar 

  42. Eisman B, Beart R, Norton L. Multiple organ failure. Surgery Gynaecology Obstetrics. 1977;144:323–5.

    Google Scholar 

  43. Fry DE, Pearlstein L, Fulton RL, Polk Jr HC. Multiple system organ failure. The role of uncontrolled infection. Arch Surg. 1980;115:136–40.

    PubMed  CAS  Google Scholar 

  44. Faist E, Baue AE, Dittmer H, Heberer G. Multiple organ failure in polytrauma patients. J Trauma. 1983;23:775–87.

    PubMed  CAS  Google Scholar 

  45. Goris JA, Boekhoerst TP, Nuytinck JK, Gimbrere JS. Multiple organ failure. Arch Surg. 1985;120:1109–15.

    PubMed  CAS  Google Scholar 

  46. Norton LW. Does drainage of intra-abdominal pus reverse multiple organ failure? Am J Surg. 1985;149:347–50.

    PubMed  CAS  Google Scholar 

  47. Giannoudis PV. Current concepts of the inflammatory response after major trauma: an update. Injury. 2003;34:397–404.

    PubMed  CAS  Google Scholar 

  48. Cipolle MD, Pasquale MD, Cerra FB. Secondary organ dysfunction: from clinical perspectives to molecular mediators. Crit Care Clin. 1993;9:261–97.

    PubMed  CAS  Google Scholar 

  49. DeLong Jr WG, Born CT. Cytokines in patients with polytrauma. Clin Orthop Relat Res. 2004;422:57–65.

    PubMed  Google Scholar 

  50. Maekawa K, Futami S, Nishida M, Terada T, Inagawa H, Suzuki S, et al. Effects of trauma and sepsis on soluble L-selectin and cell surface expression of L-selectin and CD11b. J Trauma. 1998;44:460–8.

    PubMed  CAS  Google Scholar 

  51. Pape HC, Schmidt RE, Rice J, et al. Biochemical changes following trauma and skeletal surgery of the lower extremity – quantification of the operative burden. Crit Care Med. 2000;28:3441–8.

    PubMed  CAS  Google Scholar 

  52. Frink M, van Griensven M, Kobbe P, Brin T, Zeckey C, Vaske B, et al. IL-6 predicts organ dysfunction and mortality in patients with multiple injuries. Scand J Trauma Resusc Emerg Med. 2009;17:49.

    PubMed  Google Scholar 

  53. Castelli GP, Pognani C, Cita M, Paladini R. Procalcitonin as a prognostic and diagnostic toll for septic complications after major trauma. Crit Care Med. 2009;37(6):1845–9.

    PubMed  Google Scholar 

  54. Carillo C, Fogler RJ, Shaftan GW. Delayed gastrointestinal reconstruction following massive abdominal trauma. J Trauma. 1993;34:233–5.

    Google Scholar 

  55. Buckle R, Browner B, Morandi M. Emergency reduction for pelvic ring disruptions and control of associated hemorrhage using the pelvic stabilizer. Tech Orthop. 1995;9:258–66.

    Google Scholar 

  56. Gansslen A, Pohlemann T, Paul C, et al. Epidemiology of pelvic ring injuries. Injury. 1996;27:S-A13–9.

    Google Scholar 

  57. Kellam J. The role of external fixation in pelvic disruptions. Clin Orthop. 1989;241:66–82.

    PubMed  Google Scholar 

  58. Musemeche CA, Fischer RP, Cotler HB, Andrassy RJ. Selective management of pediatric pelvic fractures: a conservative approach. J Pediatr Surg. 1987;22:538–40.

    PubMed  CAS  Google Scholar 

  59. Poka A, Libby E. Indications and techniques for external fixation of the pelvis. Clin Orthop. 1996;329:54–9.

    PubMed  Google Scholar 

  60. Riska E, von Bonsdorf H, Hakkinen S, et al. External fixation of unstable pelvic fractures. Int Orthop. 1997;3:183–8.

    Google Scholar 

  61. Krige JE, Bornman PC, Terblanche J. Therapeutic perihepatic packing in complex liver trauma. Br J Surg. 1992;79:43–6.

    PubMed  CAS  Google Scholar 

  62. Little JM, Fernandes A, Tait N. Liver trauma. Aust NZJ Surg. 1986;56:613–9.

    CAS  Google Scholar 

  63. Parreira JG, Solda S, Rasslan S. Damage control. A tactical alternative for the management of exsanguinating trauma patients. Arq Gastroenterol. 2002;39:188–97.

    PubMed  Google Scholar 

  64. Shapiro MB, Jenkins DH, Schwab CW, et al. Damage control: collective review. J Trauma. 2000;49:969–78.

    PubMed  CAS  Google Scholar 

  65. Frevert S, Dahl B, Lönn L. Update on the role of angiography and embolisation in pelvic fracture. Injury. 2008;39(11):1290–4.

    PubMed  Google Scholar 

  66. Constantini TW, Bosarge PL, Fortlage D, Bansal V, Coimbra R. Arterial embolization for pelvic fractures after blunt trauma: are we all talk? Am J Surg. 2010;200(6):752–7.

    Google Scholar 

  67. Hauser CJ, Zhou X, Joshi P, Cuchens MA, et al. The immune microenvironment of human fracture/soft-tissue haematomas and its relationship to systemic immunity. J Trauma. 1997;42:895–903.

    PubMed  CAS  Google Scholar 

  68. Hauser CJ, Joshi P, Zhou X, et al. Production of interleukin-10 in human fracture soft-tissue haematomas. Shock. 1996;6:3–6.

    PubMed  CAS  Google Scholar 

  69. Perl M, Gebhard F, Knöferl MW, et al. The pattern of preformed cytokines in tissue frequently affected by blunt trauma. Shock. 2003;19:299–304.

    PubMed  CAS  Google Scholar 

  70. Giannoudis PV, Cohen A, Hinsche A, et al. Simultaneous bilateral femoral fractures: systemic complications in 14 cases. Int Orthop. 2000;24:264–7.

    PubMed  CAS  Google Scholar 

  71. Raman R, Sidhom S, Pape HC, Giannoudis PV. Systemic effects of bilateral tibial versus bilateral femoral shaft fractures. Is there a difference? Acta Orthop Belg. 2004;70:134–41.

    PubMed  Google Scholar 

  72. Copeland CE, Mitchell KA, Brumback RJ, et al. Mortality in patients with bilateral femoral fractures. J Orthop Trauma. 1998;12:315–9.

    PubMed  CAS  Google Scholar 

  73. Daniel RK, Taylor GI. Distant transfer of an island flap by microvascular anastomoses. A clinical technique. Plast Reconstr Surg. 1973;52:111–7.

    PubMed  CAS  Google Scholar 

  74. Lange RH, Bach AW, Hansen ST, Johansen KH. Open tibial fractures with associated vascular injuries: prognosis for limb salvage. J Trauma. 1985;25:203–8.

    PubMed  CAS  Google Scholar 

  75. Georgiadis GM, Behrens FF, Joyce MJ, Earle AS, Simmons AL. Open tibial fractures with severe soft-tissue loss. Limb salvage compared with below-the-knee amputation. J Bone Joint Surg Am. 1993;75-A:1431–41.

    Google Scholar 

  76. Gregory RT, Gould RJ, Peclet M, et al. The mangled extremity syndrome (M.E.S.): A severity grading system for multisystem injury of the extremity. J Trauma. 1985;22:1147–50.

    Google Scholar 

  77. Johansen K, Daines M, Howey T, Helfet D, Hansen ST. Objective criteria accurately predict amputation following lower extremity trauma. J Trauma. 1990;30:568–73.

    PubMed  CAS  Google Scholar 

  78. Bhandari M, Guyatt GH, Swiontkowski MF, Schemitsch EH. Treatment of open fractures of the shaft of the tibia. A systematic overview and meta-analysis. J Bone Joint Surg Br. 2001;83-B:62–8.

    Google Scholar 

  79. Helfet DL, Howey T, Sanders R, et al. Limb salvage versus amputation: preliminary results of the Mangled Extremity Severity Score. Clin Orthop. 1990;256:80–6.

    PubMed  Google Scholar 

  80. Robertson PA. Prediction of amputation after severe lower limb trauma. J Bone Joint Surg Br. 1991;73-B:816–8.

    Google Scholar 

  81. Smith RM, Gopal S. Mini-symposium: tibial fractures. Open fractures: principles of management. Curr Orthop. 1999;13:87–91.

    Google Scholar 

  82. Durrant CA, Mackey SP. Orthoplastic classification systems: the good, the bad, and the ungainly. Ann Plast Surg. 2011;66(1):9–12.

    PubMed  CAS  Google Scholar 

  83. Bosse MJ, MacKenzie EJ, Kellam JF, et al. An analysis of outcomes of reconstruction or amputation of leg-threatening injuries. New Engl J Med. 2002;347:1924–31.

    PubMed  Google Scholar 

  84. MacKenzie EJ, Bosse MJ, The LEAP Study Group. Disability persists long term following severe lower limb trauma. Paper #68 presented at the Orthopaedic Trauma Association Annual Meeting, Hollywood; October 10, 2004.

    Google Scholar 

  85. Goodell JA, Flick AB, Herbet JC, Howe JG. Preparation and release characteristics of tobramycin-impregnated polymethylmethacrylate beads. Am J Hosp Pharm. 1986;43:1454–61.

    PubMed  CAS  Google Scholar 

  86. Webb LX. New techniques in wound management: vacuum-assisted wound closure. I Am Acad Orthop Surg. 2002;10:303–11.

    Google Scholar 

  87. Zalavras CG, Patzakis MJ, Holtom P. Local antibiotic therapy in the treatment of open fractures and osteomyelitis. Clin Orthop Relat Res. 2004;427:86–93.

    PubMed  Google Scholar 

  88. Beck JP, Colins JA. Theoretical and clinical aspects of post-traumatic fat embolism syndrome. AAOS ICL. 1973;22:38–44.

    Google Scholar 

  89. Chestnut RM. Secondary brain insults after head injury: clinical perspectives. New Horiz. 1995;3:366–9.

    Google Scholar 

  90. Lehmann U, Reif W, Hobbensiefken G, et al. Effect of primary fracture management on craniocerebral trauma in polytrauma. An animal experiment study. Unfallchirurg. 1995;98:437–41.

    PubMed  CAS  Google Scholar 

  91. Chan PH, Schmidley JW, Fishman RA, et al. Brain injury, edema and vascular permeability changes induced by oxygen-derived free radicals. Neurology. 1984;34:315–8.

    PubMed  CAS  Google Scholar 

  92. Schoettle RJ, Kochanek PM, Nemoto EM, et al. Granulocyte accumulation and edema after cerebral trauma. Crit Care Med. 1989;17:71–5.

    Google Scholar 

  93. Schmoker JD, Zhuang J, Shackford SR. Hemorrhagic hypotension after brain injury causes an early sustained reduction in cerebral oxygen delivery despite normalisation of systemic oxygen delivery. J Trauma. 1992;32:714–8.

    PubMed  CAS  Google Scholar 

  94. Pietropaoli JA, Rodgers FB, Shackford SM, et al. The deleterious effect of intraoperative hypotension on outcome in patients with severe head injuries. J Trauma. 1992;33:403–7.

    PubMed  CAS  Google Scholar 

  95. Price JE, Murray A. The influence of hypoxia and hypotension on recovery from head injury. Injury. 1972;3:218–21.

    PubMed  CAS  Google Scholar 

  96. Grotz MR, Giannoudis PV, Pape HC, et al. Traumatic brain injury and stabilisation of long bone fractures. An update. Injury. 2004;35:1077–86.

    PubMed  CAS  Google Scholar 

  97. Boulanger BR, Stephen D, Brenneman FD. Thoracic trauma and early intramedullary nailing of femur fractures: are we doing harm? J Trauma. 1997;43:24–8.

    PubMed  CAS  Google Scholar 

  98. Charash WE, Fabian TC, Croce MA. Delayed surgical fixation of femur fractures is a risk factor for pulmonary failure independent of thoracic trauma. J Trauma. 1994;37:667–72.

    PubMed  CAS  Google Scholar 

  99. Nicholas B, Toth L, van Wessem K, Evans J, Enninghorst N, Balogh ZJ. Borderline femur fracture patients: early total care or damage control orthopaedics? ANZ J Surg. 2011;81(3):148–53.

    PubMed  Google Scholar 

  100. Pape HC, van Griensen M, Rice J, et al. Major secondary surgery in blunt trauma patients and peri-operative cytokine liberation: determination of the clinical relevance of biochemical markers. J Trauma. 2001;50:989–1000.

    PubMed  CAS  Google Scholar 

  101. Harwood PJ, Giannoudis PV, van Griensven M, Krettek C, Pape HC. Alterations in the systemic inflammatory response after early total care and damage control procedures for femoral shaft fracture in severely injured patients. J Trauma. 2005;58:446–52.

    PubMed  Google Scholar 

  102. McGraw JM, Lim EV. Treatment of open tibial shaft fracture. External fixation and secondary intramedullary nailing. J Bone Joint Surg. 1988;70A:900–11.

    Google Scholar 

  103. Maurer DJ, Merkow RL, Gustilo RB. Infection after intramedullary nailing of severe open tibial fractures initially treated with external fixation. J Bone Joint Surg. 1989;71A:835–8.

    Google Scholar 

  104. Blachut PA, Meek RN, O’Brien PJ. External fixation and delayed intramedullary nailing of open fractures of the tibial shaft. J Bone Joint Surg. 1990;72A:729–34.

    Google Scholar 

  105. Wheelwright EF, Court-Brown CM. Primary external fixation and secondary intramedullary nailing in the treatment of tibial fractures. Injury. 1993;23:373–5.

    Google Scholar 

  106. Antich-Adrover P, Marti-Garin D, Murias-Alvarez J, Peunte-Alonso C. External fixation and secondary intramedullary nailing of open tibial fractures. J Bone Joint Surg. 1997;79B:433–7.

    Google Scholar 

  107. Paderni S, Trentani P, Grippo G, et al. Intramedullary osteosynthesis after external fixation. Chir Organi Mov. 2001;86:183–90.

    PubMed  CAS  Google Scholar 

  108. Wolinsky PR, McCarty E, Shyr Y, Johnson K. Reamed intramedullary nailing of the femur: 551 cases. J Trauma. 1999;46:392–9.

    PubMed  CAS  Google Scholar 

  109. Bhandari M, Guyatt GH, Tong D, Adili A, Shaughnessy SA. Reamed versus nonreamed intramedullary nailing of lower extremity long bone fractures: a systematic overview and meta-analysis. J Orthop Trauma. 2000;14:2–9.

    PubMed  CAS  Google Scholar 

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Pape, HC., Dienstknecht, T., Giannoudis, P.V. (2012). Damage Control Orthopedics in the Polytrauma Patient. In: Seligson, D., Mauffrey, C., Roberts, C. (eds) External Fixation in Orthopedic Traumatology. Springer, London. https://doi.org/10.1007/978-1-4471-2197-8_1

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