Pape et al identified a group of trauma patients who may deteriorate after surgery. These "borderline" patients may benefit from damage control orthopedic (DCO) surgery. The authors are from Hannover Medical School in Germany.


Patients may include:

(1) presence of polytrauma with any one of the following:

(1a) with Injury Severity Scale (ISS) score > 20 AND Abbreviated Injury Scale (AIS) for thoracic injury > 2

(1b) with Injury Severity Scale (ISS) score > 40

(1c) with significant abdominal and/or pelvic injuries and an initial systolic blood pressure < 90 mm Hg (hemodynamic shock)

(2) presence of trauma with lung injury manifested by any of the following:

(2a) bilateral lung contusions on imaging studies

(2b) mean pulmonary arterial pressure > 24 mm Hg initially

(2c) increase in pulmonary artery pressure > 6 mm Hg during intramedullary nailing



• The increase in pulmonary artery pressure is assumed to be the systolic pressure.

• Significant abdominal and/or pelvic injury correlates with a level > 3 according to Moore and Moore.


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