TY  - JOUR
T1  - Adult Trauma: Getting Through the Night
AU  - Schmidt, Andrew H.
AU  - Anglen, Jeffrey
AU  - Nana, Arvind D.
AU  - Varecka, Thomas F.
Y1  - 2010/02/01
N1  - 
JO  - The Journal of Bone & Joint Surgery
SP  - 490
EP  - 505
VL  - 92
IS  - 2
N2  - 
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.

SN  - 0021-9355
M3  - doi: 
UR  - http://dx.doi.org/
ER  -