Damage Control in Orthopedics

Damage Control in Orthopedics

Damage Control in Orthopedics

I’m Ed Smith, a Sacramento Personal Injury Lawyer. In recent years, the medical community has been wrestling with an important decision regarding patients who suffer polytrauma from traumatic injuries that leads to multiple bone fractures: should they perform early external fixation as a bridge to more permanent surgical fixation? Or should they wait? A paper published in the Journal of Trauma Injury and Critical Care explores just that.

Early External Fixation or Early Internal Intervention?

If patients aren’t intervened with early external fixation (using medical equipment to stabilize the fractures until the patient is ready for surgical treatment), the alternative would be to intervene immediately with surgical treatment to put the bones back together. Many patients with femur fractures would prefer this; however, many patients who suffer femur fractures from auto accidents or trucking accidents have a host of other injuries that accompany a femur fracture. These injuries could make the patient hemodynamically unstable, meaning that their heart rate, blood pressure, and breathing status could be compromised. This patient may not be healthy enough to tolerate surgery.

Early Internal Intervention has Problems

The paper published points out that other research studies have demonstrated that patients who head to the operating room with multiple internal injuries have higher rates of complications including severe blood loss and pulmonary emboli. In patients who have also suffered a skull fracture or traumatic brain injury, their outcomes are notably worse. In patient with head injuries who are placed under anesthesia, it is difficult to monitor their neurological function because they’re asleep during the procedure. This makes it difficult to assess the status of the patient.

The Results of Early External Fixation

The paper goes on to review hundreds of charts of patients who have suffered femur fractures in recent years. They compared the outcomes of patients who received early external fixation with the outcomes of patients who received early internal intervention. Overall, the patients who had early external fixation, meaning they had their femur fracture stabilized by medical equipment prior to permanent surgical intervention, had better outcomes than patients who received early internal intervention. The definition of “better” means that they had improved surgical outcomes and lower rates of complications and comorbidities. Notably, the patients who received early external fixation had more severe femur fractures because if the femur fracture wasn’t as severe, they likely would have received early internal intervention. Overall, early external fixation can be used as an alternative to early internal intervention in patients who are “sicker,” meaning hemodynamically unstable, because it offers a way to stabilize a patient through minimal blood loss until the patient is deemed healthy enough for surgical intervention.

Experienced Bone Fracture & Personal Injury Lawyers

I’m Ed Smith, a Sacramento Personal Injury Lawyer. The treatment decisions regarding traumatic injuries can be difficult to process. Anyone suffering a traumatic bone fracture may call me at (916) 921-6400 for friendly, free legal advice. I also offer a toll-free line at (800) 404-5400.

I am a member of the California chapter of the Million Dollar Advocates Forum. Our group has many of the top-rated trial lawyers in the country. Every group member has obtained verdicts in excess of $1 Million for clients in past cases.

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Image Attribution: By © Nevit Dilmen, CC BY-SA 3.0,

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