Zusammenfassung
„Damage Control Orthopedics“ ist eine Strategie zur Versorgung von Frakturen bei Schwerverletzten mit dem Ziel, Sekundärschäden zu minimieren und das Outcome der Patienten zu maximieren. Dabei wird bei relevanten Frakturen auf die primär definitive Osteosynthese verzichtet und stattdessen eine temporäre Stabilisierung mittels Fixateur externe durchgeführt. Durch den kleineren Eingriff und die kurze Operationszeit soll die zusätzliche Traumabelastung im Sinne des „second hit“ möglichst gering gehalten werden. Nach Stabilisierung des Patienten auf der Intensivstation kann dann nach 4–14 Tagen die definitive Osteosynthese sekundär vorgeommen werden.
Die vorliegenden tierexperimentellen Studien sowie retrospektiven klinischen Untersuchungen und prospektiven Fallserien scheinen das Konzept zu stützen. Die bisher einzige randomisierte Studie zeigte einen Vorteil für diese Strategie in der Untergruppe der „Borderlinepatienten“. Eine Metaanalyse fand keine abschließende Evidenz, die den Vorteil dieser Strategie belegen konnte. Eine neue multizentrische, randomisierte Studie wurde begonnen, die das Konzept Damage Control bei einer definierten Gruppe kritisch verletzter Patienten mit einer Femurschaftfraktur untersucht.
Abstract
Damage Control Orthopedics is a strategy for treatment of fractures in severely injured patients. The aim is to reduce secondary damage and thereby improve the patient’s outcome. The relevant fractures are primarily stabilized with external fixators instead of a primary definitive osteosynthesis. The less traumatic and shorter surgical procedure is thought to reduce the additional trauma load and should thereby minimize the “second hit” situation. After stabilization of the patient on the intensive care unit secondary definitive ostesynthesis can then be performed after 4–14 days.
The available animal studies, retrospective clinical studies and prospective cohort studies seem to support the concept of damage control. The only available randomized study shows an advantage of this strategy in a subgroup of borderline patients. A meta-analysis could not find convincing evidence that definitively proves the advantage of this concept. A new multi-center randomized study has been started to evaluate the concept of damage control in a defined group of critically injured patients with femoral shaft fractures.
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Bouillon, B., Rixen, D., Maegele, M. et al. Damage Control Orthopedics. Unfallchirurg 112, 860–869 (2009). https://doi.org/10.1007/s00113-009-1598-x
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DOI: https://doi.org/10.1007/s00113-009-1598-x