RT Journal
A1 Schmidt, Andrew H.
A1 Anglen, Jeffrey
A1 Nana, Arvind D.
A1 Varecka, Thomas F.
T1 Adult Trauma: Getting Through the Night
JF The Journal of Bone & Joint Surgery
JO The Journal of Bone & Joint Surgery
YR 2010
FD February 1
VO 92
IS 2
SP 490
OP 505
DO 
UL http://dx.doi.org/
AB 
There has been a dramatic change in the approach to the treatment of acute musculoskeletal injuries over the past decade. The previous emphasis on so-called "early total care," which advocated immediate definitive repair of all injuries, has shifted to an approach emphasizing "damage control orthopaedics" for a multiply injured patient. In this new paradigm, definitive repair of fractures is delayed until the patient is stabilized physiologically, associated soft-tissue injuries (if present) have healed, and optimum resources are available. However, there remain situations in which immediate treatment may be needed, such as in a patient with a pelvic ring injury and hemodynamic instability, a compartment syndrome, or an irreducible joint dislocation with associated neurovascular compromise. In these circumstances, there may not be time to safely transfer the patient to a specialized center, and emergent treatment directed at the specific problem must be provided. Emergent treatment of open fractures, compartment syndrome, and hemodynamic instability in a patient with a pelvic fracture as well as damage control in multiply injured patients should be understood by all who treat musculoskeletal injuries. Finally, a less-often discussed but no less important aspect of surgical care that may affect initial treatment decisions and outcome is sleep deprivation and fatigue of the members of the surgical team.