Multiple Trauma

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أصابتهم اذا أصابتهم الذين اذا الذينوانا لله انا قالوا وانا مصيبة لله انا قالوا مصيبة

راجعون راجعون اليه أولئك أولئك 00اليهمن صلوات من عليهم صلوات عليهم

وأولئك ورحمة وأولئك ربهم ورحمة ربهمالمهتدون المهتدون هم : 00هم اآلية) : البقرة اآلية) ( ( 157157--156156البقرة

الرحمن الله الرحمن بسم الله بسمالرحيمالرحيم

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Musculo-SkeletalMusculo-SkeletalTraumaTrauma

Dr. Abdullah H.A. JumaFRCS(Ed.)

Associate Professor and Consultant Orthopedic surgery

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Musculo-skeletal TraumaTrauma:Trauma:

•T = Taker.

•R = Rural.

•A = And.

•U = Urban.

•M = Mankind.

•A = Assets.

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Musculo-skeletal Trauma

Trauma:Trauma:

•Is an epidemic phenomenon with a widespread global distribution affecting both sexes and all ages.

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Types:Types:

•RTA, MVA.

•Domestic.

•Sports.

•Occupational.

•Industrial.

•War.

•Natural disaster.

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RTA & MVARTA & MVA

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DomesticDomestic

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SportsSports

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OccupationalOccupational

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IndustrialIndustrial

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WarWar

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Natural disastersNatural disasters

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Open fractureOpen fracture

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Classification according to order Classification according to order of priority in management:of priority in management:

•Highest priority:

•Cervical spine injury.

•Respiratory impairment.

•Cardiovascular insufficiency.

•Severe external haemorrhage.Larkin J and Moylan J: (1973): Priorities in management of

trauma victims. Critical Care Medicine, 3: 192-195.

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Classification according to order Classification according to order of priority in management:of priority in management:(Cont.)(Cont.)

•High priority:

•Intraperitoneal injuries.

•Retroperitoneal injuries.

•Brain and spinal cord injuries.

•Severe burns, or extensive soft tissue injuries. (Larkin and Moylan, 1973)

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Classification according to order of Classification according to order of priority in management: priority in management: (Cont.)(Cont.)

•Low priority:

•Lower genito-urinary tract injuries.

•Peripheral vascular, nerve and tendon injuries.

•Fractures, dislocations.

•Facial and soft tissue injuries.

•Tetanus prophylaxis.(Larkin and Moylan, 1973)

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Injury Severity Score (ISS) Injury Severity Score (ISS) (Baker (Baker et al., 1997):et al., 1997):

Baker SP, O’neill B, Haddow W and Long WB )1974(: The injury severity score : A method for describing patients with multiple injuries and evaluating emergency care. J.Trauma, 14:187-196.

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Triage Score Triage Score (Champion et al., 1980):(Champion et al., 1980):

Champion HR, Sacco WJ, Hannan DS, Lepper RL, Atzinger ES, Copes WS and Proll RH)1980(: Assessment of injury severity: The Triage Index. Critical Care Medicine, 8: 201-208.

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Glasgow Coma Scale Glasgow Coma Scale (Teasdale and (Teasdale and Jennet, 1974)Jennet, 1974)

Teasdale G and Jennet B )1974(: Assessment of coma and impaired consciousness. Lancet, 2: 81-84.

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•Polytraumatized or multiple injury patients possess the most critical decision and management.

•A trauma centre, well equipped, well staffed, highly experienced personnel, easy and fast accessibility with multi-system and multi-speciality medical care should be available.


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•The aim of treatment will be:

CONCLUSION:CONCLUSION:

•Prevention of accidents and trauma to occur.

•Prevention of further damage to the human skeleton.

•Prevention of recurrence of trauma.


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•“Remember, we are human beings, having our own limitations, but fully responsible of providing our best care.

Supportive Care:Supportive Care:

•“I treated him . . . God cured him”

(Ambroise Pare’ 1510-90)

(A.Juma)


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•Pulmonary support.

•Cardiovascular support.

•Renal support.

•Hepatic support.

•Nutritional support.

•Metabolic support.

•Musculo-skeletal and rehabilitative support.

•Psychological support.

These supportive Care Include:These supportive Care Include:Musculo-skeletal Trauma

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Relationship Relationship between mean daily between mean daily

urine nitrogen urine nitrogen excretion for 7 days excretion for 7 days postoperatively, the postoperatively, the

blood level of blood level of branched chain a.a. branched chain a.a.

on the 7th after on the 7th after injury and the initial injury and the initial ketone body levels.ketone body levels.

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The concentrated The concentrated ketone bodies in the ketone bodies in the

blood of patients blood of patients after injuryafter injury

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Changes in the blood Changes in the blood brached chain a.a. brached chain a.a.

after injuryafter injury

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The mean excretion The mean excretion of 3-methylhistidine of 3-methylhistidine

in the urine in ten in the urine in ten injured patients injured patients

without without hyperketonaemiahyperketonaemia

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The variation in The variation in the phases of the phases of

injury according injury according to its natureto its nature

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Some effects of Some effects of burns on hormonal burns on hormonal

controlcontrol

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Fat can not be used as a source of glucoseFat can not be used as a source of glucose

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Relationship between hormones and Relationship between hormones and substrates in mansubstrates in man

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MethylhistidineMethylhistidine

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Metabolic pathways of animo acidsMetabolic pathways of animo acids

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The central position of the liver as a transformer The central position of the liver as a transformer between fuel supply and fuel consumersbetween fuel supply and fuel consumers

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Diagrammatic representation of some changes in Diagrammatic representation of some changes in body composition induced by severe injurybody composition induced by severe injury

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•Multiple fractures especially when involving long bones, especially in lower extremities.

•Spinal injuries with its risk to the neural elements.

•Pelvic injuries with its impact on the contained viscera.

•Complicated fractures by vascular, neurological and soft tissue damage.

Musculoskeletal trauma has a special Musculoskeletal trauma has a special consideration and challenges in:consideration and challenges in:


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•Open fractures especially grade II, III A,B,C.

•Contamination yielding to infections.

•Fractures involving joints.

•Fractures with bone losses.

•Mismanaged bones and joints after injury.



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•Complications of fracture healing.

•Medical diseases imposing variable threats to the victims of bone and joint injury.

•The availability versus lack of instrumentation, implants, expertise, medical and paramedical staff.



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•First aid and ATLS measures provided in situ at the site of accident.

•Access and effective transfer into a trauma center.

•Thorough and careful assessment of the patient using different score systems.

•Detailed study of the type of fractures, plan and timing of intervention.

Management will depend on:Management will depend on:Musculo-skeletal Trauma

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•Reduction )closed vs. open(.

•Immobilization )closed vs. open(.

•Rehabilitation.

Based on this, treatment will proceed to:Based on this, treatment will proceed to:Musculo-skeletal Trauma

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•Prevention of the risk factors causing injuries.These can be accessible in 30% of the cases, whereas the rest of them need public and governmental support.

CONCLUSION:CONCLUSION:Musculo-skeletal Trauma

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•A trauma center is a mandatory factor in managing trauma patients to improve the mortality and morbidity rates of injuries.

RECOMMENDATION:RECOMMENDATION:Musculo-skeletal Trauma

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Thank you Thank you From

Dr. Abdullah H.A. JumaFRCS(Ed.)

Associate Professor and Consultant Orthopedic surgery

Health & Medicine

Multiple Trauma