This AAOS instructional course lecture defines which adult orthopaedic trauma conditions demand emergent surgery and which can safely wait under damage control principles. It covers open fractures, compartment syndrome, pelvic ring injuries, upper- and lower-extremity emergencies, and surgeon fatigue. The target audience is any orthopaedic surgeon managing trauma during off-hours when senior backup may be limited.
Trauma call puts residents in exactly the situations this paper addresses: a polytrauma patient arrives at midnight and you need to decide right now whether to nail the femur, take the pelvis to angiography, or defer everything until morning.
When your polytrauma patient has a serum lactate above 2.5 mmol/L, provisional stabilization with external fixation is the right move — nailing the femur in that physiologic state doubles complications. Resuscitate first, operate later.
When a patient's compartment pressure produces a delta-P below 30 mmHg and that value is rising or sustained, fasciotomy is indicated. Do not wait for the classic five P's. Those are late findings, and by the time paralysis appears, muscle is already dying.
For pelvic ring injuries with hemorrhagic shock, apply a sheet or binder immediately (within 15 minutes) and follow a structured protocol. The data show mortality drops from 35% to 7% with protocol adherence. This is not a minor process improvement.
The section on surgeon fatigue is a rare explicit reminder that your judgment at hour 28 of a shift is measurably impaired. Recognizing when to defer a complex articular reconstruction until a rested team is available is itself good surgical decision-making.
This AAOS instructional course lecture defines which adult orthopaedic trauma conditions demand emergent surgery and which can safely wait under damage control principles. It covers open fractures, compartment syndrome, pelvic ring injuries, upper- and lower-extremity emergencies, and surgeon fatigue. The target audience is any orthopaedic surgeon managing trauma during off-hours when senior backup may be limited.
Trauma call puts residents in exactly the situations this paper addresses: a polytrauma patient arrives at midnight and you need to decide right now whether to nail the femur, take the pelvis to angiography, or defer everything until morning.
When your polytrauma patient has a serum lactate above 2.5 mmol/L, provisional stabilization with external fixation is the right move — nailing the femur in that physiologic state doubles complications. Resuscitate first, operate later.
When a patient's compartment pressure produces a delta-P below 30 mmHg and that value is rising or sustained, fasciotomy is indicated. Do not wait for the classic five P's. Those are late findings, and by the time paralysis appears, muscle is already dying.
For pelvic ring injuries with hemorrhagic shock, apply a sheet or binder immediately (within 15 minutes) and follow a structured protocol. The data show mortality drops from 35% to 7% with protocol adherence. This is not a minor process improvement.
The section on surgeon fatigue is a rare explicit reminder that your judgment at hour 28 of a shift is measurably impaired. Recognizing when to defer a complex articular reconstruction until a rested team is available is itself good surgical decision-making.