Damage Control Orthopaedics

Damage control orthopaedics (DCO) is an approach to prevent further damage of soft tissues, control haemorrhage and improve overall physiology of the multiply injured patient. This concept is not new as early immobilization of fracture has been a well known method to prevent further tissue damage, control of internal haemorrage and prevent fat embolism. External splintage using Crammer wire, Thomas splint, skeletal traction and balanced suspension on Balkan frame are well known procedures for DCO. Later on various external fixators have been used for the same purpose. Hoffman fixator, Anderson linkage system, AO fixator and Ilizarov ring fixator are few names to mention. Recently the concept of DCO is under active discussion and its principles being laid down. The main concern is to stabilize the patient physiologically using minimum procedures and delay defenitive procedures. ABCs of trauma management and early external stabilization is done achieve physiological stability, and then definitive treatment is done.

Physiology of Damage Control Orthopaedics
The physiologic basis of damage control orthopaedics is beginning to be understood. Traumatic injury leads to systemic inflammation (systemic inflammatory response syndrome or SIRS) followed by a period of recovery mediated by a counter-regulatory anti-inflammatory response or CARS. Severe inflammation may lead to acute organ failure and early death after an injury. A lesser inflammatory response followed by an excessive compensatory anti-inflammatory response syndrome may induce a prolonged immunosuppressed state that can be deleterious to the host. This conceptual framework may explain why multiple organ dysfunction syndrome develops early after trauma in some patients and much later in others.

The concept of DCO is very well discussed in the video presentation by Dr. John M Sojka.
Dr. Sojka is certified by the American Board of Orthopaedic Surgery. He completed a fellowship in orthopaedic traumatology at Methodist Hospital. He earned his medical degree from the University of Kansas School of Medicine and completed his residency at Creighton University School of Medicine. Dr. Sojka has a comprehensive practice involving acute traumatic orthopaedic injuries with post-traumatic reconstructive services.
Source of information: http://www.kumc.edu/school-of-medicine/orthopedics/physicians-and-staff/faculty-physicians/john-sojka.html

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