Damage Control Orthopaedics in Spinal Trauma

The management of spinal injuries in polytrauma patients has evolved significantly in recent years. Published in The Journal of the American Academy of Orthopaedic Surgeons, a comprehensive analysis highlights the shift from traditional early total care (ETC) to more nuanced approaches like damage control orthopedics (DCO) and early appropriate care.

Evolution of Trauma Management

Historically, polytrauma treatment focused on immediate and complete surgical fixation of all fractures (ETC). However, DCO emerged as a strategy for hemodynamically unstable patients, involving temporary measures like external fixation or splinting to stabilize fractures, with definitive surgery delayed until patient stabilization. Early appropriate care represents a middle-ground approach, aiming for relatively early intervention when safe and beneficial.

Key Concepts for Spinal Trauma

The principles of DCO are less clearly defined for spinal injuries compared to long bone fractures. Important considerations include:

• Prioritization: In polytrauma patients with both spinal and pelvic fractures, or those with multiple, non-contiguous spinal fractures, surgeons face complex decisions on which injuries to address first. A framework for prioritizing interventions based on the patient's overall condition and specific injury characteristics is essential.

• Timing of Surgery: Factors influencing the optimal timing of spinal surgery in polytrauma patients must balance the need for stabilization with the risks of early, aggressive intervention in unstable patients.

• Surgical Techniques: The role of minimally invasive versus open surgical techniques in the context of damage control and early appropriate care is an important consideration.

• Construct Planning: Management of both contiguous and non-contiguous spinal injuries requires careful planning in construct design.