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  • Print publication year: 2008
  • Online publication date: January 2010

15 - Musculoskeletal Trauma

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Summary

Objectives

Define goals in the management of musculoskeletal trauma.

Discuss the potential advantages and disadvantages of early fracture fixation.

Describe patient and injury characteristics necessary to formulate a treatment plan.

Develop treatment strategies for urgent and emergent musculoskeletal problems.

GENERAL APPROACH TO MUSCULOSKELETAL TRAUMA CARE

Introduction

Trauma is the leading cause of death and disability in the United States in people under the age of 45 years, accounting for more than 100,000 deaths each year, and annual medical expenses of more than $200 billion [1–3]. Most trauma-related deaths are associated with closed-head injuries or exsanguination shortly after the injury. Patients who survive the initial traumatic event are at risk for various life-threatening complications, many of which are directly related to their musculoskeletal injuries. Trauma care is evolving to address the initial musculoskeletal insult and treat or avoid secondary complications. Essential goals of treatment include resuscitation, pain relief, improved stability and alignment, enhanced mobility, and ultimately restoration of function.

Goals of treatment

Resuscitation

The American College of Surgeons Committee on Trauma has developed Advanced Trauma Life Support (ATLS) protocols to aid in the initial evaluation and resuscitation of the trauma patient [4]. These validated protocols are practiced at trauma centers throughout the United States and involve primary, secondary, and tertiary surveys of the patient. The primary survey is a stepwise evaluation of airway, breathing, circulation, disability, and exposure. This primary survey is followed by a secondary survey in which a detailed history and physical examination is completed.

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