Extract
Many orthopaedic patients who have sustained multiple injuries benefit from
the early total care of major bone fractures. However, the strategy is not the
best option, and indeed might be harmful, for some multiply injured patients.
Since foregoing all early surgery is not the optimal approach for those
patients, the concept of damage control orthopaedics has evolved. Damage
control orthopaedics emphasizes the stabilization and control of the injury,
often with use of spanning external fixation, rather than immediate fracture
repair. The concept of damage control orthopaedics is not new; it has evolved
out of the rich history of fracture care and abdominal surgery. This article
traces the roots of damage control orthopaedics, reviews the physiologic basis
for it, describes the subgroups of patients and injury complexes that are best
treated with damage control orthopaedics, reports the early clinical results,
and provides a rationale for modern fracture care for the multiply injured
patient.