Trauma current issue

Fracture healing and bone repair: an update

Mon, 20 Jul 2009 08:14:23 PDT

Bone healing represents a physiological process of repair and restoration of function. Recent advances in a variety of medical disciplines have enabled scientists and clinicians to characterise this phenomenon at the molecular level. A number of molecular mediators and cells interact utilising different pathways. Despite the involvement of many local and systemic factors failure of the naturally occurring mechanisms can occur leading to either delayed union or non-union. This review article is focused on the recent understanding of the mechanisms governing the bone repair process.

Major trauma in the elderly

Sarkar, S. N — Mon, 20 Jul 2009 08:14:23 PDT

With people living longer and able to undertake more activities, any professional involved in trauma care will inevitably be exposed to older victims of trauma. Increasing numbers of older people are admitted to trauma units, presenting the healthcare professional with challenges including altered physiology, polypharmacy and ethical considerations which may lead to diagnostic and treatment dilemmas. Rib fractures for example are associated with significant morbidity and mortality and optimising analgesia may improve outcomes. There are conflicting views over co-morbidities being associated with mortality, but mortality in UK intensive care units appears to be high in elderly trauma victims. The EAST guidelines provide a thorough management strategy of elderly trauma victims. Old age should not be a sole criterion for limiting or withholding care in trauma patients.

The classification and principles of management of wounds in trauma

Barnard, A., Allison, K. — Mon, 20 Jul 2009 08:14:23 PDT

The correct assessment and early management of wounds is vital in achieving a good outcome in both the acute and chronic setting. A robust management plan for the trauma patient depends upon accurate and timely assessment of all injuries and evaluation of key features such as mechanism of injury, pre-hospital findings and intervention, zone of injury, patient characteristics and structures damaged. This article describes the general principles of wound assessment and management, discussing mechanism and zone of injury, debridement techniques, types of irrigation and the use of antibiotic prophylaxis. Particular attention is given to the management of open tibial fractures, fasciotomy wounds, pretibial lacerations and haematomas and bite wounds.

Traumatic amputation -- a contemporary approach

Healey, A. J, Tai, N. — Mon, 20 Jul 2009 08:14:23 PDT

The management of patients with loss or near loss of a limb secondary to high-energy trauma is particularly challenging. Management consists of an acute phase of resuscitation and initial surgery, followed by a longer chronic phase, consisting of rehabilitation, fitting of a prosthesis and stump care. Acute assessment by the full trauma team along standard ABCDE guidelines should not conflict with early stemming of on-going stump or limb haemorrhage as required. Patients with traumatic limb loss are likely to be shocked and have traumatic coagulopathy; initial and on-going resuscitation should satisfy the need to replace blood with packed cells and plasma in a 1 : 1 ratio consistent with the concept of `Damage Control Resuscitation'. The surgical goal is to tailor surgery to the patients' physiological state, removing dead and unviable tissue, restoring perfusion to live tissue, stabilising fractured bone and addressing the loss of soft tissues. The imperative to preserve length should not outweigh the need to leave the patient with a stump that will heal in a timely fashion. Lifelong prosthetic preventive maintenance is paramount as residual limbs change in volume with muscle atrophy and changes inpatient weight. Replacement may also be indicated as improved designs appear from time to time. Early rehabilitation and prosthetic fitting also improves routine prosthetic use, which has been found to positively affect return to work.

Traumatic hip dislocation in adults

Deakin, D., Porter, K. — Mon, 20 Jul 2009 08:14:23 PDT

Traumatic hip dislocation occurs during high-energy trauma and is often associated with other life threatening injuries. Dislocation can be anterior or posterior and urgent reduction is mandatory to reduce the risk of avascular necrosis of the femoral head. Undisplaced femoral neck fractures should be excluded prior to attempted reduction. Various closed reduction techniques have been described and most dislocations can be reduced with a closed technique. Failure to achieve reduction makes open reduction mandatory. This review describes the diagnosis, investigation and management of this complex and challenging injury.