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Orthopaedics
Damage Control Orthopedics (DCO)
Built from Orthopedic Trauma Essentials
What’s inside
6 sections · 93 slides
Overview
- What this topic covers
- Polytrauma is more than broken bones
- Four names you will meet
From the clock to the patient
How four paradigms replaced each other, and why
- Early Total Care - the first big idea
- The trial that launched early fixation
- Reaming the femur did not wreck the chest
- Where Early Total Care stopped working
- How one injury becomes two
- The second hit, in plain words
- Damage Control Orthopedics - the staged answer
- The damage control pathway
- Why waiting helps the body
- Damage control's own weak spot
- Early Appropriate Care - numbers, not days
- What those three numbers actually mean
- What Early Appropriate Care delivered - and did not
- Safe Definitive Surgery - keep asking the question
- “
- What SDS wants to see before it says yes
- Four paradigms, one direction of travel
- How to read the paradigm table
- Evolution of polytrauma management: philosophy and timing
- Evolution of polytrauma management: key physiological indications
- Evolution of polytrauma management: advantages and limitations
- Part one in one line
When physiology says stay in damage control
The thresholds that defer definitive fixation
- No single number makes the decision
- Acidosis is the central signal
- But the metabolism can lie
- The signs of a body out of reserve
- The lethal triad and its triggers
- What 'cleared for definitive surgery' means
- Five findings that favour damage control
- How to read the physiology table
- Physiologic parameters guiding DCO vs. definitive fixation in Safe Definitive Surgery (SDS)
- Physiologic parameters guiding DCO vs. definitive fixation in Safe Definitive Surgery (SDS) (continued)
- Four kinds of polytrauma patient
- How to read the classification table
- Physiologic classification of polytrauma patients: typical findings
- Physiologic classification of polytrauma patients: strategy and rationale
- Part two in one line
When to convert to the final implant
Femur, tibia, closed limb fractures, pelvis and acetabulum
- The conversion question
- Femoral shaft: the 24-hour benchmark
- How to use the femur evidence
- Femoral fracture before and after intramedullary nailing
- Open limb fractures: frame time drives infection
- Remove the frame, then nail - now or in a week?
- Open tibia: convert within one to two weeks
- Open tibia: a stepwise rise with every delay
- Temporary external frame spanning an injured leg
- Circular frame on the lower leg
- Closed lower-limb fractures: a wider window
- 1.1%
- Reading the closed-fracture study honestly
- Intramedullary nail in the tibia
- Plate and screws holding an ankle fracture
- Pelvic ring: early fixation looks better
- Pelvis and acetabulum within 72 hours
- Pelvic ring: what the pooled evidence says
- External fixator frame anchored to the pelvis
- How to read the stabilisation strategy table
- Safe stabilisation strategy: suggested timing for definitive fixation
- Safe stabilisation strategy: what is safe and what to avoid
- The note printed under that table
- Part three in one line
Pin sites after the frame comes off
Stitch them or leave them open?
- The old teaching about pin holes
- The trial that overturned it
- And the pooled evidence agrees
- Why stitching is biologically sound here
- Old habit versus current evidence
- What to do at the moment of removal
- How to read the pin-site summary
- Summary of evidence on closure of external fixator pin-sites
- Part four in one line
Can a blood test decide the timing?
Biomarkers beyond lactate
- Why look past lactate
- Interleukin-6, the best-studied marker
- Operate on day 2-4 or day 5-8?
- IL-6 pooled, and a threshold
- Procalcitonin finds hidden infection
- L-selectin: promising but not ready
- Mitochondrial DNA: still experimental
- How to read the biomarker table
- Biomarkers for the transition to definitive fixation: timing and thresholds
- Biomarkers for the transition to definitive fixation: what each one predicts
- Part five in one line
- Take home: the principles
- Take home: the numbers worth remembering
- Take home: traps to avoid
- References
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- Orthopedic Trauma Essentials 2026