Damage Control Orthopaedics: Patient Stabilization, Early Mobilization

Severe orthopaedic trauma care has advanced beyond the Golden Hour — the first 60 minutes after injury — with new techniques to allow some delay while more critical injuries are treated.

Nirmal C. Tejwani, MD, moderator of a symposium on this subject at the 74th Annual Meeting of the American Academy of Orthopaedic Surgeons, comments that, “Damage control orthopaedics allows delaying the definitive orthopaedic treatment to a time when the patient’s overall condition is stabilized. External fixators can be used quickly to temporarily stabilize fractures. This approach allows time for patients to improve and for soft tissues around the fracture to partially heal.”The changing face of trauma includes new ways of treating trauma in the elderly, the obese and among those patients who suffer high-energy fractures.The energy of an injury is related to mass times velocity squared; high energy injuries involve a large mass, such as motor vehicles or high velocity like high speed crashes and gunshots. Minimally invasive techniques for use in trauma patients has lessened the large exposures previously needed. Locking plate and screws allows more secure fracture fixation and early mobilization in the elderly. This is a crucial improvement because the elderly often are unable to keep weight off a broken leg or use crutches. Early mobilization prevents problems associated with prolonged bed rest, helping to prevent pressure sores, pulmonary problems and blood clots (DVT).Recovering from trauma takes time. Dr. Tejwani advises, “The biggest misconception about fractures is the length of recovery time. Fractures generally take 12 weeks to heal and most patients are unable to resume normal activities or sports participation for three to six months.”(Source: American Academy of Orthopaedic Surgeons : March 2007.)