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Damage Control |
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Status |
Steering Committee |
Study Materials | Jump To |
| On Hold. | Mo Bhandari | Protocol | Summary | |
| Mike Bosse | Forms | Research Design | ||
| Peter Burke | Data Grid | Outcomes | ||
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5. Damage Control |
Study Registration | Alan Jones | Inclusion Criteria | |
| 6. Sacral Fractures | Pending application | Chris Pape | Exclusion Criteria | |
| 7. Ankle Plating | Emil Schemitch | |||
| 8. Scapula Fractures | Andy Schmidt | |||
| Dave Teague | ||||
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Paul Tornetta | |||
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Title
Damage Control Orthopaedics: The Effect on Local and Systemic Complications: A Multicenter Prospective Cohort Study
Orthopaedic patients that suffer from multiple traumas are at risk for developing systemic complications such as adult respiratory distress syndrome and multiple organ failure as a result from their injuries. Early decisions on how to best manage their injuries appears to influence the incidence of these complications.
The effectiveness of initial temporary stabilization of orthopaedic operations in preventing unexpected patient deterioration resulted in the development of a new approach in the management of musculoskeletal injuries in the polytraumatised patient. Damage Control Orthopeadics (DCO) attempts to minimize the risk of the onset of these life-threatening complications by selectively delaying certain surgeries and focusing on controlling trauma (i.e. hemorrhaging, soft-tissue injuries) and stabilizing fractures. During the initial surgery, minimally invasive procedures such as external fixation are preferred over internal fixation. This methodology has great potential, but has not been adequately evaluated in a large scale multicenter cohort study with numbers great enough to determine in which patients the method is needed, and further, what timing is optimal in resuscitated patients.
The objective of this study is to determine what patients might benefit most from damage control protocols and which clinical parameters are most applicable in determining the most optimal timing of surgical procedures.
The study is designed as a multicenter, longitudinal, prospective cohort study. The technical objectives will be addressed by comparisons of groups and by regression analysis
1. ISS ≥ 16 2. Femoral shaft fracture amenable to surgical fixation 3. Age ≥18 and ≤65 4. Able to sign consent or have surrogate consent
1. Unable to consent 2. Known metabolic bone disease 3. Known mental disability 4. Nonoperative femur fracture 5. Prisoner 6. Delay of > 24 hours to presentation 7. Pre-existing renal insufficiency 8. Pre-existing hepatic dysfunction 9. Pre-existing cardiac dysfunction 10. Previous myocardial infarction 11. Previous stroke 12. Vascular insufficiency 13. Neuromuscular disorder
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