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Damage Control OrthopaedicsEvolving Concepts in the Treatment of Patients Who Have Sustained Orthopaedic Trauma
Craig S. Roberts, MD1; Hans-Christoph Pape, MD2; Alan L. Jones, MD3; Arthur L. Malkani, MD1; Jorge L. Rodriguez, MD1; Peter V. Giannoudis, MD4
1 Departments of Orthopaedic Surgery (C.S.R and A.L.M.) and Surgery (J.L.R.), University of Louisville, 210 East Gray Street, Suite 1003, Louisville, KY 40202. E-mail address for C.S. Roberts: craig.roberts@louisville.edu
2 Department of Trauma Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, Hannover 30625, Germany
3 Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390-8883
4 Department of Trauma Orthopaedic Surgery, University of Leeds, Beckett Street, Leeds LS9 7TF, United Kingdom
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The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Printed with permission of the American Academy of Orthopaedic Surgeons. This article, as well as other lectures presented at the Academy's Annual Meeting, will be available in February 2005 in Instructional Course Lectures, Volume 54. The complete volume can be ordered online at www.aaos.org, or by calling 800-626-6726 (8 a.m.-5 p.m., Central time).
An Instructional Course Lecture, American Academy of Orthopaedic Surgeons

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 Feb 01;87(2):434-449
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Many orthopaedic patients who have sustained multiple injuries benefit from the early total care of major bone fractures. However, the strategy is not the best option, and indeed might be harmful, for some multiply injured patients. Since foregoing all early surgery is not the optimal approach for those patients, the concept of damage control orthopaedics has evolved. Damage control orthopaedics emphasizes the stabilization and control of the injury, often with use of spanning external fixation, rather than immediate fracture repair. The concept of damage control orthopaedics is not new; it has evolved out of the rich history of fracture care and abdominal surgery. This article traces the roots of damage control orthopaedics, reviews the physiologic basis for it, describes the subgroups of patients and injury complexes that are best treated with damage control orthopaedics, reports the early clinical results, and provides a rationale for modern fracture care for the multiply injured patient.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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