J Korean Orthop Assoc.  2018 Feb;53(1):1-8. 10.4055/jkoa.2018.53.1.1.

Management of Polytrauma

• Kim JJ
• Kim KH

• KMID: 2405393
• DOI: http://doi.org/10.4055/jkoa.2018.53.1.1

Abstract

To optimize results for polytrauma patients, prompt evacuation and early management are critical. These patients also require a multidisciplinary team effort, involving multiple departments, as they are likely to have not only musculoskeletal injuries but also specific organ injuries or compromised general status. In the 1980s, the goal was definitive fracture fixation in the early stages after injury (early total care). Since the 1990s, however, the goal has shifted to temporary fixation, with a delay of several days prior to definitive fixation (damage control orthopedics). Recently, the timing and extent of treatment have been determined by the condition of patients based on objective indicators. Because surgery may result in secondary damage, it is desirable to minimize potential tissue injury with either temporary fixation or a delay in definitive fixation.

Keyword

polytrauma

MeSH Terms

Fracture Fixation
Humans
Multiple Trauma*

Figure

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  Figure 1 (A, B) A 79-year-old female patient presented pelvic fracture injured in a pedestrian traffic accident and was initially unstable hemodynamically. Initial blood pressure was 78/57 mmHg and Injury Severity Score was 42. (C) After conventional angiography and embolization of iliac vessels for suspected bleeding, closed reduction and external fixation for damage control orthopedics was performed within 24 hours of injury. (D) Six weeks after trauma, the patient's condition was tolerable, and external fixator removal and internal fixation on posterior iliac bone were performed.

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  Figure 2 (A) A 35-year-old female sustained fractures of both femur shafts after a fall-down injury. (B) Following the initial appropriate resuscitation (pH 7.4, lactate 0.8 mmol/L), definite fixation of both femur shafts was performed with intramedullary nailing.

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  Figure 3 Changing trends in orthopedic management of polytrauma patients. ETC, early total care; DCO, damage control orthopedics; EAC, early appropriate care42); SDS, safe definitive surgery.35)

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