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Orthopaedics(D
CO)
Moderator:Dr Vijay Kumar
Co-Moderator:Dr Venketish
Presenter:Dr Navin Singh
All India Institute of Medical Sciences
New Delhi
Objectives-
Polytrauma
Historical perspetive
Introduction of DCO
Pathophysiology of DCO
Literature on DCO
Polytrauma: As patients with an Abbreviated
Injury Scale (AIS) score greater than 2 in at
least two Injury Severity Score (ISS) body
regions (2 AIS score > 2).
.
Injury severity
score(ISS)-
ISS is an anatomical scoring system that provides an overall
score for patients with multiple injuries.
EARLY TOTAL
CARE(ETC)
ETC-Patients were able to mobilise early and were
discharged from hospital sooner, avoiding the
complications associated with prolonged bed rest.
J Trauma 1985;25:375-84
J Trauma 1990;30:792-8
.
J.bone jt surg.1999;81(Br):256-61
J Trauma 2003;55:7-13
First and second hit phenomenon:
Damage control philosophy in polytruma;
Surg Cdr us Dadhwar, Maj N Pathak
Patients who have sustained orthopaedic trauma have been
divided into four groups:
-stable
Borderline
unstable, and
in extremis.
Pape HC, Hildebrand F, Pertschy S, Zelle B, Ga-rapati R, Grimme K, Krettek C, Reed RL 2nd.
47
Biomechanics
48
Mechanics of Bone Pin Interface
49
Indications for Rapid Ex Fix
Patient in extremis
Massive open injury (degloving injury)
Vascular damage/repair
Mass casualities
Patient in Extremis
Multiple other severe injuries
Extreme hypotension
Coagulopathy
Massive head injury
Aortic transection
Early
Reduceskeletal
blood loss stabilization
Issues while applying
DCO-
1. Safety????