Fracture haematoma proteomics.

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Abstract

Conflict of interest statement: F. Hildebrand reports grants and consulting fees from Medudy and Stryker, unrelated to this study, and also participates in a Data Safety Monitoring Board or Advisory Board for the German Research Council, as well as a leadership or fiduciary role in the European Society of Trauma and Emergency Surgery and German Society of Orthopedics and Trauma Surgery. M. Huber-Lang is a board member and past President of the European Shock Society, President-elect of the International Federation of Shock Societies and President of the German Trauma Foundation. M. van Griensven reports royalties from Elsevier, participation on a Data Safety Monitoring Board or Advisory Board in CDT Manchester Sheffield and CIBER-BBN (Spain), reviewer grants from the European Union, NWO, and Springer Nature, all of which are unrelated to this study. M. van Griensven is also unpaid president of the basic research section of the German Society for Orthopaedics and Trauma Surgery. The authors declare that the research was conducted in the absence of any commercial, financial, or other relationships that could be construed as a potential conflict of interest. 9. World J Orthop. 2019 Jan 18;10(1):1-13. doi: 10.5312/wjo.v10.i1.1. eCollection 2019 Jan 18. Damage control orthopaedics: State of the art. Guerado E(1), Bertrand ML(2), Cano JR(2), Cerván AM(2), Galán A(2). Author information: (1)Department of Orthopaedic Surgery and Traumatology, Hospital Costa del Sol, University of Malaga, Marbella 29603, Malaga, Spain. eguerado@hcs.es. (2)Department of Orthopaedic Surgery and Traumatology, Hospital Costa del Sol, University of Malaga, Marbella 29603, Malaga, Spain. Damage control orthopaedics (DCO) originally consisted of the provisional immobilisation of long bone - mainly femur - fractures in order to achieve the advantages of early treatment and to minimise the risk of complications, such as major pain, fat embolism, clotting, pathological inflammatory response, severe haemorrhage triggering the lethal triad, and the traumatic effects of major surgery on a patient who is already traumatised (the "second hit" effect). In recent years, new locations have been added to the DCO concept, such as injuries to the pelvis, spine and upper limbs. Nonetheless, this concept has not yet been validated in well-designed prospective studies, and much controversy remains. Indeed, some researchers believe the indiscriminate application of DCO might be harmful and produce substantial and unnecessary expense. In this respect, too, normalised parameters associated with the acid-base system have been proposed, under a concept termed early appropriate care, in the view that this would enable patients to receive major surgical procedures in an approach offering the advantages of early total care together with the apparent safety of DCO. This paper discusses the diagnosis and treatment of severely traumatised patients managed in accordance with DCO and highlights the possible drawbacks of this treatment principle. DOI: 10.5312/wjo.v10.i1.1 PMCID: PMC6354106