Damage Control in Orthopedic Surgery: Fad or Fact?

The term “damage control” was originally coined by the United States Navy to describe tactical approaches to permit a damaged sea vessel in naval battle to continue functioning. Subsequent use in the medical field appears to have begun with the experience of military surgeons in Korea. General trauma surgeons extended the damage control concept to the multiply injured patient in extremis who required life-saving interventional procedures, such as laparotomy and thoracotomy, but in whom any further procedures were believed to jeopardize the potential for survival. This surgical strategy was named “damage control surgery” by Rotondo et al1 in 1993. Practices evolved to rapidly control bleeding and shock, and to relieve brain injury with procedures that were nondefinitive and less stressful to the patients’ physiology, trying to avoid the lethal triad of acidosis, hypothermia, and coagulopathy. During the 1980s and 1990s, research in multiply injured patients showed that early stabilization of long bone fractures decreased the incidence of systemic complications such as adult respiratory distress syndrome and multisystem organ failure, and decreased mortality. Early and aggressive stabilization of open fractures was found to decrease sepsis. The concept of “early total care” evolved from these findings and has become a hallmark of trauma and orthopedic care around the world.