Skip to main content
SpringerLink
Log in
Book cover

European Instructional Lectures pp 63–70Cite as

Early Total Care vs. Damage-Control Orthopedic Surgery: Evidence Based?

  • Chapter
  • First Online:

  • 1035 Accesses

Part of the book series: European Instructional Lectures ((EICL,volume 14))

Abstract

The management of musculoskeletal injuries in multiple-trauma has changed tremendously over the last decades. From the initial concept “patients are too ill to operate” to early total care (ETC) to damage-control Orthopedic surgery (DCO) and now individual concepts based on anatomical and physiological injury severity. Despite the undisputable benefit and decrease of mortality of these concepts in multiple-trauma management, fundamental evidence and large prospective randomized multicentre trials are still missing.

In this article we present the advantages and disadvantages of ETC and DCO. The crucial step for successful management of multiple-trauma is the allocation of the right surgical principle (ETC/DCO) to the right patient. This most important task is presented and discussed in a separate chapter.

© EFORT 2014

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   139.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Kleber C, Giesecke MT, Tsokos M, Haas NP, Schaser KD, Stefan P, Buschmann CT. Overall distribution of trauma-related deaths in Berlin 2010: advancement or stagnation of German trauma management? World J Surg. 2012;36(9):2125–30.

    Article  PubMed  Google Scholar 

  2. Stone HH, Strom PR, Mullins RJ. Management of the major coagulopathy with onset during laparotomy. Ann Surg. 1983;197:532–5.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Rotondo MF, Schwab CW, McGonigal MD, Phillips III GR, Fruchterman TM, Kauder DR, Latenser BA, Angood PA. ‘Damage control’: an approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma. 1993;35:375–82; discussion 382–3.

    Article  CAS  PubMed  Google Scholar 

  4. Moore EE, Burch JM, Franciose RJ, Offner PJ, Biffl WL. Staged physiologic restoration and damage control surgery. World J Surg. 1998;22:1184–90; discussion 1190–1.

    Article  CAS  PubMed  Google Scholar 

  5. Yao YM, Redl H, Bahrami S, Schlag G. The inflammatory basis of trauma/shock-associated multiple organ failure. Inflamm Res. 1998;47:201–10.

    Article  CAS  PubMed  Google Scholar 

  6. Lasanianos NG, Kanakaris NK, Dimitriou R, Pape HC, Giannoudis PV. Second hit phenomenon: existing evidence of clinical implications. Injury. 2011;42:617–29.

    Article  CAS  PubMed  Google Scholar 

  7. Cirocchi R, Abraha I, Montedori A, Farinella E, Bonacini I, Tagliabue L, Sciannameo F. Damage control surgery for abdominal trauma. Cochrane Database Syst Rev. 2010;1, CD007438.

    PubMed  Google Scholar 

  8. Cirocchi R, Montedori A, Farinella E, Bonacini I, Tagliabue L, Abraha I. Damage control surgery for abdominal trauma. Cochrane Database Syst Rev. 2013;3, CD007438.

    PubMed  Google Scholar 

  9. Burch JM, Ortiz VB, Richardson RJ, Martin RR, Mattox KL, Jordan Jr GL. Abbreviated laparotomy and planned reoperation for critically injured patients. Ann Surg. 1992;215:476–83; discussion 483–4.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. Raeburn CD, Moore EE, Biffl WL, Johnson JL, Meldrum DR, Offner PJ, Franciose RJ, Burch JM. The abdominal compartment syndrome is a morbid complication of postinjury damage control surgery. Am J Surg. 2001;182:542–6.

    Article  CAS  PubMed  Google Scholar 

  11. Letoublon C, Cardin N, Arvieux C. Laparostomy with vacuum pack technique. Ann Chir. 2005;130:587–9.

    Article  CAS  PubMed  Google Scholar 

  12. Germanos S, Gourgiotis S, Villias C, Bertucci M, Dimopoulos N, Salemis N. Damage control surgery in the abdomen: an approach for the management of severe injured patients. Int J Surg. 2008;6:246–52.

    Article  PubMed  Google Scholar 

  13. Curry N, Davis PW. What’s new in resuscitation strategies for the patient with multiple trauma? Injury. 2012;43:1021–8.

    Article  CAS  PubMed  Google Scholar 

  14. Dunham CM, Bosse MJ, Clancy TV, Cole Jr FJ, Coles MJ, Knuth T, Luchette FA, Ostrum R, Plaisier B, Poka A, Simon RJ. Practice management guidelines for the optimal timing of long-bone fracture stabilization in polytrauma patients: the EAST Practice Management Guidelines Work Group. J Trauma. 2001;50:958–67.

    Article  CAS  PubMed  Google Scholar 

  15. Caba-Doussoux P, Leon-Baltasar JL, Garcia-Fuentes C, Resines-Erasun C. Damage control orthopaedics in severe polytrauma with femur fracture. Injury. 2012;43 Suppl 2:S42–6.

    Article  PubMed  Google Scholar 

  16. Townsend RN, Lheureau T, Protech J, Riemer B, Simon D. Timing fracture repair in patients with severe brain injury (Glasgow Coma Scale score <9). J Trauma. 1998;44:977–82; discussion 982–3.

    Article  CAS  PubMed  Google Scholar 

  17. 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; discussion 621–3.

    Article  CAS  PubMed  Google Scholar 

  18. Pape HC, Hildebrand F, Pertschy S, Zelle B, Garapati R, Grimme K, Krettek C, Reed II RL. Changes in the management of femoral shaft fractures in polytrauma patients: from early total care to damage control orthopedic surgery. J Trauma. 2002;53:452–61; discussion 461–2.

    Article  PubMed  Google Scholar 

  19. Rixen D, Steinhausen E, Sauerland S, Lefering R, Meier M, Maegele MG, Bouillon B, Neugebauer EA. Protocol for a randomized controlled trial on risk adapted damage control orthopedic surgery of femur shaft fractures in multiple trauma patients. Trials. 2009;10:72.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Nahm NJ, Vallier HA. Timing of definitive treatment of femoral shaft fractures in patients with multiple injuries: a systematic review of randomized and nonrandomized trials. J Trauma Acute Care Surg. 2012;73:1046–63.

    Article  PubMed  Google Scholar 

  21. Seibel R, LaDuca J, Hassett JM, Babikian G, Mills B, Border DO, Border JR. Blunt multiple trauma (ISS 36), femur traction, and the pulmonary failure-septic state. Ann Surg. 1985;202:283–95.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  22. Stubig T, Mommsen P, Krettek C, Probst C, Frink M, Zeckey C, Andruszkow H, Hildebrand F. Comparison of early total care (ETC) and damage control orthopedics (DCO) in the treatment of multiple trauma with femoral shaft fractures: benefit and costs. Unfallchirurg. 2010;113:923–30.

    Article  CAS  PubMed  Google Scholar 

  23. Lefaivre KA, Starr AJ, Stahel PF, Elliott AC, Smith WR. Prediction of pulmonary morbidity and mortality in patients with femur fracture. J Trauma. 2010;69:1527–35; discussion 1535–6.

    Article  PubMed  Google Scholar 

  24. D’Alleyrand JC, O’Toole RV. The evolution of damage control orthopedics: current evidence and practical applications of early appropriate care. Orthop Clin North Am. 2013;44:499–507.

    Article  PubMed  Google Scholar 

  25. Reynolds MA, Richardson JD, Spain DA, Seligson D, Wilson MA, Miller FB. Is the timing of fracture fixation important for the patient with multiple trauma? Ann Surg. 1995;222:470–8; discussion 478–81.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  26. O’Toole RV, O’Brien M, Scalea TM, Habashi N, Pollak AN, Turen CH. Resuscitation before stabilization of femoral fractures limits acute respiratory distress syndrome in patients with multiple traumatic injuries despite low use of damage control orthopedics. J Trauma. 2009;67:1013–21.

    Article  PubMed  Google Scholar 

  27. Pape HC, Grimme K, Van Griensven M, Sott AH, Giannoudis P, Morley J, Roise O, Ellingsen E, Hildebrand F, Wiese B, Krettek C. Impact of intramedullary instrumentation versus damage control for femoral fractures on immunoinflammatory parameters: prospective randomized analysis by the EPOFF Study Group. J Trauma. 2003;55:7–13.

    Article  PubMed  Google Scholar 

  28. Anwar IA, Battistella FD, Neiman R, Olson SA, Chapman MW, Moehring HD. Femur fractures and lung complications: a prospective randomized study of reaming. Clin Orthop Relat Res. 2004;422:71–6.

    Article  PubMed  Google Scholar 

  29. Canadian Orthopaedic Trauma Society. Reamed versus unreamed intramedullary nailing of the femur: comparison of the rate of ARDS in multiple injured patients. J Orthop Trauma. 2006;20:384–7.

    Article  Google Scholar 

  30. Goldstein A, Phillips T, Sclafani SJ, Scalea T, Duncan A, Goldstein J, Panetta T, Shaftan G. Early open reduction and internal fixation of the disrupted pelvic ring. J Trauma. 1986;26:325–33.

    Article  CAS  PubMed  Google Scholar 

  31. Sala F, Capitani D, Castelli F, La Maida GA, Lovisetti G, Singh S. Alternative fixation method for open femoral fractures from a damage control orthopaedics perspective. Injury. 2010;41:161–8.

    Article  PubMed  Google Scholar 

  32. Fox LC, Kreishman MP. High-energy trauma and damage control in the lower limb. Semin Plast Surg. 2010;24:5–10.

    Article  PubMed Central  PubMed  Google Scholar 

  33. Taeger G, Ruchholtz S, Waydhas C, Lewan U, Schmidt B, Nast-Kolb D. Damage control orthopedics in patients with multiple injuries is effective, time saving, and safe. J Trauma. 2005;59:409–16; discussion 417.

    Article  PubMed  Google Scholar 

  34. Tuttle MS, Smith WR, Williams AE, Agudelo JF, Hartshorn CJ, Moore EE, Morgan SJ. Safety and efficacy of damage control external fixation versus early definitive stabilization for femoral shaft fractures in the multiple-injured patient. J Trauma. 2009;67:602–5.

    Article  PubMed  Google Scholar 

  35. Strecker W, Gonschorek O, Fleischmann W, Bruckner U, Beyer M, Kinzl L. Thromboxane – co-factor of pulmonary disturbances in intramedullary nailing. Injury. 1993;24 Suppl 3:S68–72.

    Article  PubMed  Google Scholar 

  36. Waydhas C, Nast-Kolb D, Trupka A, Zettl R, Kick M, Wiesholler J, Schweiberer L, Jochum M. Posttraumatic inflammatory response, secondary operations, and late multiple organ failure. J Trauma. 1996;40:624–30; discussion 630–1.

    Article  CAS  PubMed  Google Scholar 

  37. 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; discussion 452–4.

    Article  PubMed  Google Scholar 

  38. Scannell BP, Waldrop NE, Sasser HC, Sing RF, Bosse MJ. Skeletal traction versus external fixation in the initial temporization of femoral shaft fractures in severely injured patients. J Trauma. 2010;68:633–40.

    Article  PubMed  Google Scholar 

  39. Morshed S, Miclau III T, Bembom O, Cohen M, Knudson MM, Colford Jr JM. Delayed internal fixation of femoral shaft fracture reduces mortality among patients with multisystem trauma. J Bone Joint Surg Am. 2009;91:3–13.

    Article  PubMed Central  PubMed  Google Scholar 

  40. Jaicks RR, Cohn SM, Moller BA. Early fracture fixation may be deleterious after head injury. J Trauma. 1997;42:1–5; discussion 5–6.

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  42. Pape HC, van Griensven M, Rice J, Gansslen A, Hildebrand F, Zech S, Winny M, Lichtinghagen R, Krettek C. Major secondary surgery in blunt trauma patients and perioperative cytokine liberation: determination of the clinical relevance of biochemical markers. J Trauma. 2001;50:989–1000.

    Article  CAS  PubMed  Google Scholar 

  43. Dimar JR, Carreon LY, Riina J, Schwartz DG, Harris MB. Early versus late stabilization of the spine in the polytrauma patient. Spine. 2010;35:S187–92.

    Article  PubMed  Google Scholar 

  44. Stahel PF, VanderHeiden T, Flierl MA, Matava B, Gerhardt D, Bolles G, Beauchamp K, Burlew CC, Johnson JL, Moore EE. The impact of a standardized “spine damage-control” protocol for unstable thoracic and lumbar spine fractures in severely injured patients: a prospective cohort study. J Trauma Acute Care Surg. 2013;74:590–6.

    Article  PubMed  Google Scholar 

  45. Croce MA, Bee TK, Pritchard E, Miller PR, Fabian TC. Does optimal timing for spine fracture fixation exist? Ann Surg. 2001;233:851–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  46. Rutges JP, Oner FC, Leenen LP. Timing of thoracic and lumbar fracture fixation in spinal injuries: a systematic review of neurological and clinical outcome. Eur Spine J. 2007;16:579–87.

    Article  PubMed Central  PubMed  Google Scholar 

  47. Bellabarba C, Fisher C, Chapman JR, Dettori JR, Norvell DC. Does early fracture fixation of thoracolumbar spine fractures decrease morbidity or mortality? Spine. 2010;35:S138–45.

    Article  PubMed  Google Scholar 

  48. Schinkel C, Anastasiadis AP. The timing of spinal stabilization in polytrauma and in patients with spinal cord injury. Curr Opin Crit Care. 2008;14:685–9.

    Article  PubMed  Google Scholar 

  49. Kerwin AJ, Griffen MM, Tepas 3rd JJ, Schinco MA, Devin T, Frykberg ER. Best practice determination of timing of spinal fracture fixation as defined by analysis of the National Trauma Data Bank. J Trauma. 2008;65:824–30; discussion 830–1.

    Article  PubMed  Google Scholar 

  50. Rixen D, Grass G, Sauerland S, Lefering R, Raum MR, Yucel N, Bouillon B, Neugebauer EA. Evaluation of criteria for temporary external fixation in risk-adapted damage control orthopedic surgery of femur shaft fractures in multiple trauma patients: “evidence-based medicine” versus “reality” in the trauma registry of the German Trauma Society. J Trauma. 2005;59:1375–94; discussion 1394–5.

    Article  PubMed  Google Scholar 

  51. Pape HC, Rixen D, Morley J, Husebye EE, Mueller M, Dumont C, Gruner A, Oestern HJ, Bayeff-Filoff M, Garving C, Pardini D, van Griensven M, Krettek C, Giannoudis P. Impact of the method of initial stabilization for femoral shaft fractures in patients with multiple injuries at risk for complications (borderline patients). Ann Surg. 2007;246:491–9; discussion 499–501.

    Article  PubMed Central  PubMed  Google Scholar 

  52. Pape HC, Giannoudis PV, Krettek C, Trentz O. Timing of fixation of major fractures in blunt polytrauma: role of conventional indicators in clinical decision making. J Orthop Trauma. 2005;19:551–62.

    Article  PubMed  Google Scholar 

  53. Nahm NJ, Como JJ, Wilber JH, Vallier HA. Early appropriate care: definitive stabilization of femoral fractures within 24 hours of injury is safe in most patients with multiple injuries. J Trauma. 2011;71:175–85.

    Article  PubMed  Google Scholar 

  54. Waibel BH, Rotondo MM. Damage control surgery: it’s evolution over the last 20 years. Rev Col Bras Cir. 2012;39:314–21.

    Article  PubMed  Google Scholar 

  55. Tscherne H, Oestern HJ, Sturm JA. Stress tolerance of patients with multiple injuries and its significance for operative care. Langenbecks Arch Chir. 1984;364:71–7.

    Article  CAS  PubMed  Google Scholar 

  56. Burchardi H, Sydow M, Crozier TA, Burgdorff J. Organ failure in patients with multiple trauma. The effect of early osteosynthesis of fractures on complications. Anasth Intensivther Notfallmed. 1990;25:64–71.

    Article  CAS  PubMed  Google Scholar 

  57. van Os JP, Roumen RM, Schoots FJ, Heystraten FM, Goris RJ. Is early osteosynthesis safe in multiple trauma patients with severe thoracic trauma and pulmonary contusion? J Trauma. 1994;36:495–8.

    Article  PubMed  Google Scholar 

  58. Kutscha-Lissberg F, Hopf FK, Kollig E, Muhr G. How risky is early intramedullary nailing of femoral fractures in polytraumatized patients? Injury. 2001;32:289–93.

    Article  CAS  PubMed  Google Scholar 

  59. Brundage SI, McGhan R, Jurkovich GJ, Mack CD, Maier RV. Timing of femur fracture fixation: effect on outcome in patients with thoracic and head injuries. J Trauma. 2002;52:299–307.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Center for Musculoskeletal Surgery, Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany

    Christian Kleber & Norbert P. Haas

Authors
  1. Christian Kleber
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Norbert P. Haas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christian Kleber .

Editor information

Editors and Affiliations

  1. Royal National Orthopaedic Hospital Trust, Stanmore, Middlesex, United Kingdom

    George Bentley

Rights and permissions

Reprints and permissions

Copyright information

© 2014 EFORT

About this chapter

Cite this chapter

Kleber, C., Haas, N.P. (2014). Early Total Care vs. Damage-Control Orthopedic Surgery: Evidence Based?. In: Bentley, G. (eds) European Instructional Lectures. European Instructional Lectures, vol 14. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-54030-1_6

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-54030-1_6

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-54029-5

  • Online ISBN: 978-3-642-54030-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation