Damage Control Orthopedics in Patients With Multiple Injuries Is Effective, Time Saving, and Safe

Taeger, G.; Ruchholtz, Steffen; Waydhas, Christian; Lewan, Ulrike; Schmidt, B.F.; Nast-Kolb, D.

doi:10.1097/01.ta.0000175088.29170.3e

Cited by 151 publications

(80 citation statements)

References 48 publications

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“…According to the damage control orthopedics concept [23,28], delaying further diagnostics is acceptable if the treatment of life-threatening injuries took precedence over the validation of the vessel injury. The four-vessel-angiography was performed as soon as the general condition of the patient permitted.…”

Section: Screening Protocol and Diagnostic Cascadementioning

confidence: 99%

Blunt cerebrovascular injuries in acute trauma care: a screening protocol

et al. 2011

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Introduction Blunt cerebrovascular injuries (BCVI) of the extra-or intracerebral vessels are frequently observed lesions which may lead to thrombembolic events with focal neurological deficits, stroke or death particularly in patients \60 years. However, a comprehensive standardised clinical algorithm for screening and management of these secondary injuries is still lacking. Materials and methods We developed a standardised screening protocol applicable for mild as well as severely injured patients. In this prospective cohort study, we evaluated the feasibility of this diagnostic algorithm in a level 1 trauma centre setting. Trauma patients who met the inclusion criteria underwent a computed tomographic angiography (CTA) as part of standard diagnostic procedure at admission. All suspicions or positive findings were reevaluated by a conventional four-vessel catheter angiography within the first 72 h after trauma. Within this period, anticoagulation with low-dose heparin was started. BCVI confirmation indicated a shift to systemic heparinisation with overlapping phenprocoumon therapy for at least 6 months. All patients were reevaluated after 6 months by another four-vessel angiography. Depending on the diagnostic findings, oral anticoagulation may be discontinued or continued for another 6 months.Results A total of 44 patients (8 male, 6 female, age range 19-95 years) were included in the study. 20 BCVIs were detected in 16 patients (36.3%). The most common injuries identified were Biffl Type II (40%) and Type IV lesions (30%). 86.4% of the patients received a CTA upon admission, 93.2% of which were conducted within 12 h posttrauma. None of the patients had a secondary thrombembolic neurological event during the hospital stay or within 3 months postdischarge. Conclusion Our results indicate that implementation of the screening protocol can prevent strokes in patients without primary thrombembolic neurological deficits.

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Section: Screening Protocol and Diagnostic Cascadementioning

confidence: 99%

Blunt cerebrovascular injuries in acute trauma care: a screening protocol

et al. 2011

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“…External fixation provides rigid bony stabilization and can be used as definitive fixation for some types of pelvic fractures (25,26). If external fixation is to be used, expertisemust be available.…”

Section: Treating Pelvic Hemorrhagementioning

confidence: 99%

Multidisciplinary Approach for Patients with Pelvic Fractures and Hemodynamic Instability

2007

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the hemodynamically unstable patient with apelvic fracture presents adiagnostic and therapeutic challenge. the care of these patients requires au nique multidisciplinary approach with input and expertise from many different specialists. an understandingof pelvic anatomy and fracture patterns can help guide the diagnostic evaluation and treatment plan.t he initial management of these patients must focus on rapid airwaya nd hemorrhage controlw hile preparing for ongoing blood loss. Rapid temporary fracture stabilization with simple bedside modalities is crucial in limiting additional blood loss. an exhaustive search must also be performed to evaluate for concomitant injuries that commonly accompany majorp elvic fractures and the treatment of these other injuries must be appropriately prioritized. for patients who are unresponsive to standard resuscitation and bedside attempts at limiting hemorrhage, angiographic embolization is often utilizedasthe next step to attain hemodynamic stability.the key to successful management of these patients lies in the careful coordinationo fd ifferent specialists and the expertise that each brings to the clinical care of the patient.

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“…While the event that caused trauma cannot be influenced, and primary resuscitation depends on various circumstances, emergency room algorithms can be defined and learned. These standards, however, are influenced by advances such as those due to the introduction of new diagnostic methods (ultrasound, CT scan) [1,2] or therapeutic protocols (damage control surgery) [3][4][5][6]. However, severely traumatized patients suffer from a wide variety of injury patterns, a common problem with clinical studies in this field.…”

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confidence: 99%

Focus on: Diagnostic and prognosis of severely traumatized patients

Trentz¹,

Marzi²

2009

Eur J Trauma Emerg Surg

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Focus on: Diagnostic and Prognosis of Severely Traumatized PatientsMajor trauma, usually associated with hemorrhagic shock, requires the utmost effort to ensure survival and optimal rehabilitation. While the event that caused trauma cannot be influenced, and primary resuscitation depends on various circumstances, emergency room algorithms can be defined and learned. These standards, however, are influenced by advances such as those due to the introduction of new diagnostic methods (ultrasound, CT scan) [1,2] or therapeutic protocols (damage control surgery) [3][4][5][6]. However, severely traumatized patients suffer from a wide variety of injury patterns, a common problem with clinical studies in this field.Predicting survival by determining physiological parameters such as base excess, lactate and pH is one way of defining the severity of hemorrhagic shock. These physiological parameters, which are accounted for in trauma scores, appear to be of the greatest prognostic value when assessed during the first hour after admission, as reported in this issue by Abt et al. [7] from the Zurich Trauma Center. As well as physiological scores, anatomical scores are also very important, and combining both scores seems a reasonable approach. However, the tremendous variety of injury patterns, both anatomically and physiologically, makes them difficult to grade. A further step towards improving trauma scores is presented by Lefering [8], who describes the revised injury severity classification score (RISC), an outcome prediction score that takes the individual pattern of injury into account. This new score allows severely traumatized patients to be compared while accounting for their individual patterns. It is one of the main evaluative tools used in the German Trauma Registry, and shows great promise [1,[9][10][11][12].Furthermore, comparisons between trauma centers can be problematic, since trauma patterns differ significantly between countries and areas [13]. In the paper of Wyen et al. [14], the injury patterns and diagnostic algorithms in an urban German university trauma center are depicted. The predominance of blunt trauma and importance of diagnostic timeliness over a five-year period are discussed. In this respect, optimized diagnostic procedures are warranted to ensure that important pathologies are not overlooked. It seems that missed injuries only lead to a fatal outcome in a minority of cases, as the important study of Sö derlund et al. [15] demonstrates in an eight-year evaluation of early deaths in the emergency room. In certain cases, however, missing diagnoses or interpretations could have saved individual patients.Interestingly, optimal diagnostic procedures not only prevent early trauma deaths; they can also predict the amount of posttraumatic inflammation. Maier et al. [16] demonstrated that the initial detection of lung contusions by spiral CT caused an immediate enhanced inflammatory response in combination with severe lung dysfunction. Moreover, patients with comparable injury severities but without in...

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Damage Control Orthopedics in Patients With Multiple Injuries Is Effective, Time Saving, and Safe

Cited by 151 publications

References 48 publications

Blunt cerebrovascular injuries in acute trauma care: a screening protocol

Blunt cerebrovascular injuries in acute trauma care: a screening protocol

Multidisciplinary Approach for Patients with Pelvic Fractures and Hemodynamic Instability

Focus on: Diagnostic and prognosis of severely traumatized patients

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