Substantial inflammatory disturbances following major trauma have been found throughout the posttraumatic course of polytraumatized patients, which was confirmed in experimental models of trauma and in vitro settings. As a consequence, the principle of damage control surgery (DCS) has developed over the last two decades and has been successfully introduced in the treatment of severely injured patients. The aim of damage control surgery and orthopaedics (DCO) is to limit additional iatrogenic trauma in the vulnerable phase following major injury. Considering traumatic brain and acute lung injury, implants for quick stabilization like external fixators as well as decided surgical approaches with minimized potential for additional surgery-related impairment of the patient's immunologic state have been developed and used widely. It is obvious, that a similar approach should be undertaken in the case of spinal trauma in the polytraumatized patient. Yet, few data on damage control spine surgery are published to so far, controlled trials are missing and spinal injury is addressed only secondarily in the broadly used ATLS® polytrauma algorithm. This article reviews the literature on spine trauma assessment and treatment in the polytrauma setting, gives hints on how to assess the spine trauma patient regarding to the ATLS® protocol and recommendations on therapeutic strategies in spinal injury in the polytraumatized patient.

/pdf/atls-and-damage-control-in-spine-trauma-3wnj6zirg1.pdf

ATLS ® and damage control in spine trauma

The management of spine injuries in polytraumatized patients remains a great challenge for the diagnostic procedures and institution of appropriate treatment by integrating spinal trauma treatment into the whole treatment concept as well as following the treatment steps for the injured spine itself. The established concept of "damage control" and criteria regarding the optimal time and manner for operative treatment of the injured spine in the polytrauma setting is presented and discussed.

Management of spine injuries in polytraumatized patients

Objective Hand injuries are not life threatening but crucial in multiple trauma because of their long-term functional results. The goal of this systematic review was to derive recommendations for diagnostic and treatment procedures from a systematic review of the literature. Methods Articles on hand injuries in multiple trauma and articles on clinical trails for isolated hand injuries were systematically collected (MEDLINE, Cochrane, and hand searches) and classified into evidence levels (1 to 5 according to the Oxford system). Results The special management of hand injuries in multiple trauma requires accurate diagnostic procedures, differentiated therapy strategies, and adequate timing. Depending on type and extent of the injury, there are substantial differences for primary or secondary operative treatment. Conclusion Hand injuries represent important lesions in multiple trauma. Due to the life-threatening situation they may be overlooked in the beginning of the treatment. Because of their long-term consequences for function and health-related quality of life, hand injuries require an early and accurate diagnosis and a differentiated treatment strategy.

Operative strategies for hand injuries in multiple trauma. A systematic review of the literature

Fragestellung
Anhand der Ergebnisse einer Literaturrecherche sollten Empfehlungen zum Vorgehen bei Handverletzungen von polytraumatisierten Patienten abgeleitet werden.

Operative Versorgungsstrategien für Handverletzungen beim Polytrauma

In den entwickelten Industrienationen stellt das Trauma die haufigste Todesursache bei unter 40-jahrigen dar. Die praklinische Versorgung dieser Patienten beeinflusst wesentlich die Prognose hinsichtlich der Letalitat und der Morbiditat. Diese Phase ist gekennzeichnet durch die Notwendigkeit schneller Entscheidungen in kurzester Zeit unter haufig ungunstigen Bedingungen mit eingeschrankten diagnostischen und therapeutischen Mitteln. Damit steht das erstversorgende Team vor besonderen Herausforderungen. Zum praklinischen Management des Polytraumas gehoren die Untersuchung des Verletzten, die Stabilisierung der Vitalfunktionen in der speziellen Situation des hamorrhagisch-traumatischen Schocks, die Immobilisation der Wirbelsaule und die Versorgung der Einzelverletzungen. Auch Besonderheiten wie die Bergung des Verletzten, der Anfall mehrerer Verletzter, die Transport- und Zielkoordination und nicht zuletzt die Eigensicherung sind dabei zu berucksichtigen.

The preclinical care of polytraumatized patients

The data of 366 patients with multiple injuries were evaluated by application of data processing over a period of seven years. Age and sex distribution, location and combination of injuries, mortality, mechanism of accident, diagnostics as well as therapy were analysed. 91.3% of our patients had injuries of the skeleton. The male to female ratio was 2:1. In 55.4% the age of the patients ranged from 10 to 39 years. The mortality rate of all patients was 27.2%. In the third decade only 16.9% of the patients died. Whereas the mortality of the patients in the 1. decade as well as between the 7. and 9. decades of life was very high (33% and 50%). Most of the skeletal injuries were located in the shank (24% open fractures). The mortality rate increases with the number of injuries (Table III). Patients with concomitant injuries, such as head injuries and fractures of the extremities were the most common combination of multiple injuries. 20% of the patients in this group died. Patients with combined injuries of the head, chest, abdomen and skeleton had highest mortality (57%). X-ray examination of the skull, chest, extremities and mainly of the spine and pelvis should be subjects of routine diagnostics. In patients who were suspected of having a blunt abdominal trauma, the first diagnostic technique will be ultrasound. On account of the various number of concomitant injuries as well as the patients individuality, the estimation of prognosis by systems for the classification of the severity of injury is fraught with difficulties. The analysis of the evaluated data showed that previously small number of variables may predict the prognosis of the course of disease.

[Computer-assisted data analysis of injuries of the skeletal system in polytrauma patients].

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[Computer-assisted data analysis of injuries of the skeletal system in polytrauma patients].