Choufani Camille, Barbier Olivier, Grosset Antoine, Murison James Charles, Ollat Didier, Rigal Sylvain, Mathieu Laurent
Clinic of Traumatology and Orthopedics, Percy Military Hospital, Clamart, France.
Clinic of Traumatology and Orthopedics, Begin Military Hospital, Saint-Mandé, France.
Int Orthop. 2017 Sep;41(9):1771-1775. doi: 10.1007/s00264-017-3439-9. Epub 2017 Apr 10.
The damage control orthopedics (DCO) concept is a sequential surgical management strategy indicated when ideal primary treatment is not possible or suitable. DCO principles are routinely applied to hand traumas in wartime practice, but could also be useful in a civilian setting when immediate specialized management cannot be carried out.
The authors report three typical observations of soldiers treated for a complex hand trauma on the field by orthopedic surgeons from the French Military Health Service (FMHS). Application of the hand DCO concept is analyzed and discussed considering the literature and the FMHS experience.
With regards to treating the hand, DCO necessitates a meticulous debridement with precise wound assessment, the frequent use of a primary definitive internal fixation by K-wires, and the possibility of a temporary coverage. These simple and fast procedures help avoid infection and prepare the hand for secondary repair.
Hand DCO can be applied by any surgeon in various situations: in association with polytrauma, complex injuries requiring multiple reconstructions, or delayed transfer to a specialized center.
损伤控制骨科（DCO）概念是一种序贯性手术管理策略，适用于无法或不适合进行理想的一期治疗的情况。DCO原则在战时手部创伤治疗中常规应用，但在无法立即进行专业处理的 civilian 环境中也可能有用。
作者报告了法国军事卫生服务（FMHS）的骨科医生在战场上治疗复杂手部创伤的三名士兵的典型病例。结合文献和FMHS的经验，对手部DCO概念的应用进行了分析和讨论。
关于手部治疗，DCO需要进行细致的清创和精确的伤口评估，频繁使用克氏针进行一期确定性内固定，并可能进行临时覆盖。这些简单快速的程序有助于避免感染，并为手部的二期修复做好准备。
任何外科医生在各种情况下都可应用手部DCO：与多发伤相关、需要多次重建的复杂损伤或延迟转运至专科中心的情况。
