Treatment strategy for tibial plateau fractures: an update.

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Abstract

Conflict of interest statement: Conflict of Interest: None declared. 5. J Am Acad Orthop Surg. 2021 Dec 15;29(24):e1291-e1302. doi: 10.5435/JAAOS-D-21-00312. Damage Control Orthopaedics in Spinal Trauma. Oitment C(1), Thornley P, Jentzsch T, Pahuta M. Author information: (1)From the Department of Orthopedic Surgery, McMaster University, Hamilton General Hospital, Hamilton, Ontario (Oitment, Thornley, and Pahuta), the Division of Orthopaedic Surgery, Toronto Western Hospital, University Health Network (Jentzsch) and Department of Surgery, University of Toronto (Jentzsch), Toronto, Ontario, Canada, and the Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland (Jentzsch). There has been a shift in the management of the polytrauma patients from early total care to damage control orthopaedics (DCO), whereby patients with borderline hemodynamic stability may be temporized with the use of external fixators, traction, or splinting with delayed osteosynthesis of fractures. Recently, there has been an increasing trend toward a middle ground approach of Early Appropriate Care for polytrauma patients. The concepts of DCO for the spine are less clear, and the management of trauma patients with combined pelvic ring and spinal fractures or patients with noncontiguous spinal injuries present unique challenges to the surgeon in prioritization of patient needs. This review outlines the concept of DCO and Early Appropriate Care in the spine, prioritizing patient needs from the emergency department to the operating room. Concepts include the timing of surgery, minimally invasive versus open techniques, and the prioritization of spinal injuries in the setting of other orthopaedic and nonorthopaedic injuries. Contiguous and noncontiguous spinal injuries are considered in construct planning, and the principles are discussed. Copyright © 2021 by the American Academy of Orthopaedic Surgeons. DOI: 10.5435/JAAOS-D-21-00312