James Charles Murison
Received: 31 October 2016 /Accepted: 6 March 2017 / Published online: 10 April 2017
SICOT aisbl 2017
Introduction 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.
Methods 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.
Results 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 sim-
ple and fast procedures help avoid infection and prepare the
hand for secondary repair.
Conclusion 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.
Keywords Damage control surgery
Damage control orthopedics (DCO) is an emergency sur-
gical tactic revolving around three stages and based on
simple and fast initial procedures intended to stabilize
the patient and defer definitive treatment. Initially de-
scribed as a temporary external fixation of femur or pelvic
fractures in unstable polytraumatized patients, this con-
cept was extended to the management of complicated iso-
lated limb traumas for which the ideal treatment cannot be
provided at the initial phase [1–4]. DCO has now been
used for several years in civilian and military surgical
Wartime practice is characterized by almost systematic
application of sequential DCO procedures, including for
hand traumas. DCO applies simple but specific principles
that help avoid early complications and facilitate second-
ary treatment. This tactic required in low resources set-
tings and in the case of serious injury, is radically differ-
ent from the ideal one step treatment recommended by
hand surgeons since the 1970s [10–13]. However, we be-
lieve that these temporary procedures could be frequently
applied in civilian practice, especially when early patient
transfer to a specialized center is not possible.
Technical aspects of hand DCO are presented here
through three typical observations of servicemen injured
on various theatres of operations and managed by ortho-
pedic surgeons from the French Military Health Service
(FMHS). These observations are illustrative of the cir-
cumstances of hand DCO application.
* Laurent Mathieu
Clinic of Traumatology and Orthopedics, Percy Military Hospital,
Clinic of Traumatology and Orthopedics, Begin Military Hospital,
French Military Health Service Academy, Ecole du Val-de-Grâce,
Service de Chirurgie Orthopédique, Traumatologie et Chirurgie
Réparatrice des Membres, 101 avenue Henri Barbusse,
92140 Clamart, France
International Orthopaedics (SICOT) (2017) 41:1771–1775
Initial management of complex hand injuries in military
or austere environments: how to defer and prepare
for definitive repair?