David H.

Masjhoer
SMF Orthopedi & Traumatologi
RSU AW Syahranie/FK UNMUL
2
 Syndrome of multiple injuries (ISS >17) with
sequential systemic traumatic reactions which
may lead to dysfunction or failure of remote
organs and vital systems, which had not
themselves been directly injury

Fracture are more common component

 Wound of bone and soft tissue, giving rise to
stress, pain and haemorrhage
Can cause contaminate and compartment
syndromes with ischemia-reperfusion injury
Instability of fracture
 Primary Resuscitation
survey Oxygenation,
Basic imaging perfusion

Evaluation
Vital function ? Life saving
+ - surgery
Response ?

? Damage
ICU
control

Delayed
Secondary
scoring primary
survey
surgery
Stable hemodynamics
No hypoxemia, no hypercapnia
Lactate < 2 mmol/l
Normal coagulation
normothermia
Urinary output < 1 ml/kg/hour
No need for vasoactive or inotropic stimulation
Control of haemorrhage

Control of sources of
contamination Realized by :
Haemostasis
Debridement
removal of dead tissue, Fasciotomy
prevention of ischemia- Fracture fixation
reperfusion injury Tension free wound
coverage

Pain relief

Facilitation of intensive
care
 Surgical
Physiological Status Intervention Timing
Response to ( -- ) Live-Saving Surgery
resuscitation (?) Damage Control Day 1
(+) Delayed Primary Surgery
Hyper-inflammation Second look, only Day 2-3

Window of Opportunity Scheduled definitive surgery Day 5-10

Immunosuppression No Surgery
Recovery Secondary reconstructive Week 3
Surgery

( Chris L. Colton at al., AO Principles of Fracture Management, 2000 )

10
 Moderate SIRS
First insult
Moderate Immuno-
suppression

11
 Severe SIRS

Moderate SIRS
First insult
Moderate Immuno-
suppression
2nd Severe
Insult Immuno-
suppression

Definitive Surgery

12
 Severe SIRS
MOF

Moderate SIRS
First insult
Moderate Immuno-
suppression
2nd
Insult Severe
Immuno-
suppression

Definitive Surgery

13
 Severe SIRS
MOF

Moderate SIRS
First insult
Moderate Immuno-
suppression
2nd
Insult Severe
Immuno-
suppression

Definitive Surgery

Infection 14
 Severe SIRS
MOF

Moderate SIRS
First insult
Moderate Immuno-
suppression
2nd
Insult Severe
Immuno-
suppression

Definitive Surgery

MOF Infection 15
 Severe SIRS
MOF

Definitive Surgery
Moderate SIRS
First insult
Moderate Immuno-
suppression
2nd
Insult Severe
Immuno-
suppression

Definitive Surgery

MOF Infection 16