Damage Control Orthopaedics and Early Total Care
DNB Orthopaedics • October 2024 • Paper IV • 10 Marks
Introduction
Management of fractures in a polytrauma patient is governed not merely by the fracture pattern but by the patient's physiological reserve. Two classical strategies are:
Early Total Care — ETC
Early definitive fixation of major fractures, usually during the initial phase of treatment, when the patient is physiologically stable.
Damage Control Orthopaedics — DCO
Temporary, rapid skeletal stabilization in an unstable or physiologically vulnerable patient, followed by definitive fixation after recovery from the acute inflammatory and metabolic insult.
Central concept:
Stable patient → definitive fixation early.
Unstable/borderline patient → minimize additional surgical insult.
A. Early Total Care — Concept
Early Total Care refers to early definitive fixation of major fractures, especially long-bone and pelvic/acetabular injuries, once initial resuscitation has established adequate physiological stability.
The classical rationale is that early stabilization reduces the adverse systemic effects of unstable fractures and permits early mobilization.
Advantages / Rationale of ETC
- Early fracture stability
- Reduction in pain and ongoing soft-tissue trauma
- Facilitates nursing care and patient positioning
- Improves pulmonary toilet
- Allows early mobilization
- May reduce complications of prolonged recumbency
- Reduces repeated trips to the…