Severely injured patients: modern management strategies

Abstract

Management of severely injured patients remains a challenge, characterised by a number of advances in clinical practice over the last decades. This evolution refers to all different phases of patient treatment from prehospital to the long-term rehabilitation of the survivors. The spectrum of injuries and their severity is quite extensive, which dictates a clear understanding of the existing nomenclature. What is defined nowadays as polytrauma or major trauma, together with other essential terms used in the orthopaedic trauma literature, is described in this instructional review. Furthermore, an analysis of contemporary management strategies (early total care (ETG), damage control orthopaedics (DCO), early appropriate care (EAC), safe definitive surgery (SDS), prompt individualised safe management (PRISM) and musculoskeletal temporary surgery (MuST)) advocated over the last two decades is presented. A focused description of new methods and techniques that have been introduced in clinical practice recently in all different phases of trauma management will also be presented. As the understanding of trauma pathophysiology and subsequently the clinical practice continuously evolves, as the means of scientific interaction and exchange of knowledge improves dramatically, observing different standards between different healthcare systems and geographic regions remains problematic. Positive impact on the survivorship rates and decrease in disability can only be achieved with teamwork training on technical and non-technical skills, as well as with efficient use of the available resources.

European society for trauma and emergency surgery member-identified research priorities in emergency surgery: a roadmap for future clinical research opportunities

“…Damage control principles include a staged approach based on acute hemorrhage control, control of soilage due to intestinal perforation, temporary fracture fixation, and may include debridement of devitalized wounds. After ICU resuscitation and stabilization, definitive treatment may be undertaken [ 14 , 18 , 19 ]. While well-utilized after injury, it remains unclear damage control is similarly advantageous for the non-injured critically-ill surgical patient (e.g.…”

Fracture fixation in polytraumatized patients—From an interdisciplinary early total/appropriate care to the safe definitive surgery concept

“…The surgeons responded by stating that the timing of surgery no longer uses a fixed timeline, as initiated before, but a physiology-based approach is utilized (11). This use of approach is in line with our own concept, as proposed in the SDS protocol, and Prompt-Individualised-Safe (PRISM) concept by Giannoudis et al (14,15).…”

A Healed Intertrochanteric Femur Fracture, Shoulder, and Rib Fractures in an Ancient Nubian Female: An Osteoarchaeological Perspective

“…Polytrauma is defined as multiple injuries occurring at the same time [ 12 – 15 ]. This woman clearly sustained multiple fractures, but of course, it is unknown if they were all simultaneous.…”

“…This case is extremely unusual due to its archaeological age and that it demonstrated complete union before the demise of the individual. The additional left proximal humerus and rib fractures indicate further trauma and even polytrauma [ 12 – 15 ] if all the fractures occur simultaneously.…”