Damage Control Orthopedics · trauma

A borderline polytrauma patient has a femoral shaft fracture, an evolving chest injury, and a climbing lactate. Isolated-femur “early total care” energy in the room is high. The DCO move is:

• AReamed antegrade nailing now so the femur is “done”
• BSpanning external fixation tonight; convert when physiology and soft tissues allow
• CSkin traction for a week with no skeletal stability
• DBilateral retrograde nails to save time