Damage control orthopaedics (DCO) describes a philosophy for the management of the patient with multiple bony injuries. The fundamental principles are that fractures and traumatic soft tissue injuries (the `wound organ') should be stabilised promptly with the minimum physiological insult to the patient, and that initial surgery should be regarded as a staged part of the resuscitation process. This article discusses the history of DCO; the scientific basis behind DCO principles; patient selection for DCO; the principles of resuscitation in the multiply injured; the evidence for and against DCO; and possible future advances.
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