Moderator:Dr Vijay Kumar Co-Moderator:Dr Venketish All India Institute of Medical Sciences New Delhi
Moderator:Dr Vijay Kumar Co-Moderator:Dr Venketish All India Institute of Medical Sciences New Delhi
Moderator:Dr Vijay Kumar Co-Moderator:Dr Venketish All India Institute of Medical Sciences New Delhi
Co-Moderator:Dr Venketish
Presenter:Dr Navin Singh
All India Institute of Medical Sciences
New Delhi
Objectives-
Polytrauma
Historical perspetive
Introduction of DCO
Pathophysiology of DCO
Literature on DCO
Polytrauma: As patients with an Abbreviated Injury
Scale (AIS) score greater than 2 in at least two Injury
Severity Score (ISS) body regions (2 × AIS score > 2).
.
Injury severity score(ISS)-
ISS is an anatomical scoring system that provides an overall
score for patients with multiple injuries.
J Trauma 1985;25:375-84
J Trauma 1990;30:792-8
When stabilization was delayed – the incidence of
pulmonary complications was higher, the hospital and ICU
stay days were increased
Early definitive stabilization of long bone fractures
reduced the incidence of the fat embolism syndrome
compared to traditional non surgical treatment.
Early 1990:
Outcome after ETC-increased incidence of ARDS and
MOF.
J.bone jt surg.1999;81(Br):256-61
J Trauma 2003;55:7-13
First and second hit phenomenon:
Damage control philosophy in polytruma;
Surg Cdr us Dadhwar, Maj N Pathak
Patients who have sustained orthopaedic trauma have been
divided into four groups:
-stable
- Borderline
- unstable, and
- in extremis.
Pape HC, Hildebrand F, Pertschy S, Zelle B, Ga-rapati R, Grimme K, Krettek C, Reed RL 2nd.
Changes in the management of femoral shaft fractures in polytrauma patients: from early
total care to damage control orthopedic surgery.
J Trauma. 2002;53:452-62.
Stable patients-ETC
Unstable and in extremis-DCO
Borderline-
Basic strategies of DCO-
Immediate and rapid stabilization of long bone
fractures, typically with external fxation
Release of tight soft tissue compartments
(compartment syndrome)
Reductions of dislocations
Surgical debridement of open wounds
Amputation, in cases of unsalvageable extremities
Treatment goals
Stop the
ongoing injury
Facilitate
patient care
Restore
function
Stop the ongoing injury
Mediators :
• activated neutrophils
• chemical mediators
• fat emboli
• marrow contents
Remote organ injury
Stabilize
long Reduce
dislocations
bones
Debride open
wounds
Stabilize long bones
Splints &
traction
Ex-fix
Splints & traction
Best
reserved for:
Isolated Essentially
extremity stable
fractures fractures
“External Fixator is a device uses for
stabilization and immobilization of long bone
open fractures.”
Minimally invasive operations
Intrinsic
stability of frame (S)
EX I
S = -----------
L
47
Biomechanics
48
Mechanics of Bone Pin Interface
To increase stability of bone –pin interface
1. Adequate no. of pins in each fragments
( 2 for most bone & 3 for femur)
49
Indications for Rapid Ex Fix
Patient in extremis
Massive open injury (degloving injury)
Vascular damage/repair
Mass casualities
Patient in Extremis
Multiple other severe injuries
Extreme hypotension
Coagulopathy
Massive head injury
Aortic transection
Early skeletal stabilization
Improved
Improve treatment
Reduce pulmonary of head
blood loss function injured
Minimize Decrease
mediator sepsis and
release pain
Issues while applying DCO-
1. Safety????