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15 - Musculoskeletal Trauma

Published online by Cambridge University Press:  18 January 2010

By
Heather A. Vallier  and
Mark D. Jenkins
Edited by
Charles E. Smith
Heather A. Vallier
Affiliation:
Department of Orthopedic Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
Mark D. Jenkins
Affiliation:
Department of Orthopedic Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
Charles E. Smith
Affiliation:
Case Western Reserve University, Ohio
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Summary

Objectives

  1. Define goals in the management of musculoskeletal trauma.

  2. Discuss the potential advantages and disadvantages of early fracture fixation.

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

  4. 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.

Type
Chapter
Information
Trauma Anesthesia , pp. 225 - 244
Publisher: Cambridge University Press
Print publication year: 2008

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References

Committee on Trauma Research. Injury in America. A Continuing Public Health Problem. Washington, DC: National Academy Press, 1985.
Finkelstein, EA, Fiebelkorn, IC, Corso, PS, Binder, SC. Medical expenditures attributable to injuries – United States, 2000. Morb Mortal Wkly Rep 2004; 53: 1–4.Google Scholar
Rice, DP, MacKenzie, EJ, Jones, AS, et al. Cost of Injury in the United States. A Report to Congress. 1989.Google Scholar
Advanced Trauma Life Support, 6th edition. Chicago, IL: American College of Surgeons, 1997.
Waydhas, C, Nast-Kolb, D, Trupka, A.Zettl, R, Kick, M, Wiesholler, J, Schweiberer, L, Jochum, M.Posttraumatic inflammatory response, secondary operations, and late multiple organ failure. J Trauma 1996; 40(4):624–30.CrossRefGoogle ScholarPubMed
Bone, LB, Johnson, KD, Weigelt, J, Scheinberg, R.Early versus delayed stabilization of femoral fractures. A prospective randomized study. J Bone Joint Surg Am 1989; 71(3):336–40.CrossRefGoogle ScholarPubMed
Bosse, MJ, MacKenzie, EJ, Riemer, BL, Brumback, RJ, McCarthy, ML, Burgess, AR, Gens, DR, Yasui, Y.Adult respiratory distress syndrome, pneumonia, and mortality following thoracic injury and a femoral fracture treated either with intramedullary nailing with reaming or with a plate. A comparative study. J Bone Joint Surg Am 1997; 79(6):799–809.CrossRefGoogle Scholar
Charash, WE, Fabian, TC, Croce, MA.Delayed surgical fixation of femur fractures is a risk factor for pulmonary failure independent of thoracic trauma. J Trauma 1994; 37(4):667–72.CrossRefGoogle ScholarPubMed
Johnson, KD, Cadambi, A, Seibert, GB.Incidence of adult respiratory distress syndrome in patients with multiple musculoskeletal injuries: Effect of early operative stabilization of fractures. J. Trauma 1985; 25(5):375–84.CrossRefGoogle ScholarPubMed
Latenser, BA, Gentilello, LM, Tarver, AA, Thalgott, JS, Batdorf, JW.Improved outcome with early fixation of skeletally unstable pelvic fractures. J Trauma 1991; 31(1):28–31.CrossRefGoogle ScholarPubMed
Barei, DP, Nork, SE, Mills, WJ, Henley, MB, Benirschke, SK.Complications associated with internal fixation of high-energy bicondylar tibial plateau fractures utilizing a two-incision technique. J Orthop Trauma 2004; 18: 649–57.CrossRefGoogle ScholarPubMed
Sirkin, M, Sanders, R, DiPasquale, T, Herscovici, DJ Jr.A staged protocol for soft tissue management in the treatment of complex pilon fractures. J Orthop Trauma 1999; 13: 78–84.CrossRefGoogle ScholarPubMed
Goris, RJ, Gimbrere, JS, Niekerk, JL, Schoots, FJ, Booy, LH. Early osteosynthesis and prophylactic mechanical ventilation in the multitrauma patient. J Trauma 1982; 22: 895–903.CrossRefGoogle ScholarPubMed
Lozman, J.Deno, DC, Feustel, PJ, Newell, JC, Stratton, HH, Sedransk, N, Dutton, R, Fortune, JB, Shah, DM.Pulmonary and cardiovascular consequences of immediate fixation or conservative management of long-bone fractures. Arch Surg 1986; 21(9):992–9.CrossRefGoogle Scholar
McHenry, TP, Mirza, SK, Wang, J, Wade, CE, O'Keefe, GE, Dailey, AT, Schreiber, MA, Chapman, JR.Risk factors for respiratory failure following operative stabilization of thoracic and lumbar spine fractures. J Bone Joint Surg Am 2006; 88(5):997–1005.CrossRefGoogle ScholarPubMed
Seibel, R, LaDura, J, Hassett, JM, Babikian, G, Mills, B, Border, , Border, JR.Blunt multiple trauma (ISS 36), femur traction, and the pulmonary failure-septic state. Ann Surg 1985; 202: 283–95.CrossRefGoogle Scholar
Ziran, BH, Le, T, Zhou, H, Fallon, W, Wilber, JH.The impact of the quantity of skeletal injury on mortality and pulmonary morbidity. J Trauma 1997; 43(6):916–21.CrossRefGoogle ScholarPubMed
Reynolds, MA, Richardson, JD, Spain, DA, Seligson, D, Wilson, MA, Miller, FB.Is the timing of fracture fixation important for the patient with multiple trauma?Ann Surg. 1995; 222(4):470–8.CrossRefGoogle ScholarPubMed
Davis, JW, Shackford, SR, Mackersie, RC, Hoyt, DB.Base deficit as a guide to volume resuscitation. J Trauma 1988; 28(10):1464–7.CrossRefGoogle ScholarPubMed
Demling, RH.Wound inflammatory mediators and multisystem organ failure. Prog Clin Biol Res 1987; 236A: 525–37.Google ScholarPubMed
Pape, HC, Griensven, M, Rice, J, Gansslen, A, Hildebrand, F, Zech, S, Winny, M, Lichtinghagen, R, Kretteck, C.Major secondary surgery in blunt trauma patients and perioperative cytokine liberation: Determination of the relevance of biochemical markers. J Trauma 2001; 50: 989–1000.CrossRefGoogle ScholarPubMed
Pape, HC, Schmidt, RE, Rice, J, Griensven, M, Gupta, das R, Krettek, C, Tscherne, H.Biochemical changes after trauma and skeletal surgery of the lower extremity: Quantification of the operative burden. J Orthop Trauma 2004; 18(8):S24–31.CrossRefGoogle Scholar
Nast-Kolb, D, Waydhas, C, Gippner-Steppart, C, Schneider, I, Trupka, A, Ruchholtz, S, Zettl, R, Schweiberer, L, Jochum, M.Indicators of the posttraumatic inflammatory response correlate with organ failure in patients with multiple injuries. J Trauma 1997; 42(3):446–54.CrossRefGoogle ScholarPubMed
Pape, HC, Griensven, M, Sott, AH, Giannoudis, P, Morley, J, Roise, O, Ellingsen, E, Hildebrand, F, Wiese, B, Krettek, C.Impact of intramedullary instrumentation versus damage control for femoral fractures on immunoinflammatory parameters: Prospective randomized analysis by the EPOFF study group. J Trauma 2004; 55: 7–13.CrossRefGoogle Scholar
Scalea, TM, Boswell, SA, Scott, JD, et al. External fixation as a bridge to intramedullary nailing for patients with multiple injuries and with femur fractures: Damage control orthopedics. J Trauma 2000; 48: 613–23.CrossRefGoogle ScholarPubMed
Pape, HC, Hildebrand, F, Pertschy, S, Zelle, B, Garapati, R, Grimme, K, Krettek, C, Reed, RL II.Changes in the management of femoral fractures in polytrauma patients: From early total care to damage control orthopedic surgery. J Trauma 2002; 53: 452–61.CrossRefGoogle ScholarPubMed
Rixen, D, Grass, G, Sauerland, S, Lefering, R, Raum, MR, Yucel, N, Bouillon, B, Neugebauer, EAM, and the Polytrauma Study Group of the German Trauma Society. Evaluation of criteria for temporary external fixation in risk-adapted damage control orthopedic surgery of femur shaft fractures in multiple trauma patients: “Evidence-based medicine” versus “Reality” in the trauma registry of the German Trauma Society. J Trauma 2005; 59(6):1375–95.CrossRefGoogle ScholarPubMed
Burgess, AR, Eastridge, BJ, Young, JW, Ellison, TS, Ellison, PS Jr, Poka, A, Bathon, GH, Brumback, RJ.Pelvic ring disruptions: Effective classification system and treatment protocols. J Trauma 1990; 30(7):848–56.CrossRefGoogle ScholarPubMed
Riska, EB, Bonsdorff, H, Hakkinen, S, Jaroma, H, Kiviluoto, O, Paavilainen, T.Primary operative fixation of long bone fractures in patients with multiple injuries. J Trauma 1977; 17: 111–21.CrossRefGoogle ScholarPubMed
Dalal, SA, Burgess, AR, Siegel, JH, Young, JW, Brumback, RJ, Poka, A, Dunham, CM, Gens, D, Bathon, H.Pelvic fracture in multiple trauma: Classification by mechanism is key to pattern of organ injury, resuscitative requirements, and outcome. J Trauma 1989; 29(7):981–1000.CrossRefGoogle ScholarPubMed
Tile, M.Acute pelvic fractures: (part) I. Causation and classification. J Am Acad Orthop Surg 1996; 4(3):143–51.CrossRefGoogle Scholar
Tile, M.Pelvic ring fractures: Should they be fixed?J Bone Joint Surg Br 1988; 70(1):1–12.CrossRefGoogle ScholarPubMed
Whitbeck, MG Jr, Zwally, HJ II, Burgess, AR.Innominosacral dissociation: mechanism of injury as a predictor of resuscitation requirements, morbidity, and mortality. J Orthop Trauma 2006; 20(1 Suppl):S57–63.Google ScholarPubMed
Vrahas, M, Hern, TC, Diangelo, D, Kellam, J.Tile, M.Ligamentous contributions to pelvic stability. Orthopaedics 1995; 18(3): 271–4.Google ScholarPubMed
Routt, ML Jr, Simonian, PT, Ballmer, F.A rational approach to pelvic trauma. Resuscitation and early definitive stabilization. Clin Orthop Relat Res 1995; (318):61–74.Google ScholarPubMed
Denis, F, Davis, S, Comfort, T.Sacral fractures: An important problem. Retrospective analysis of 236 cases. Clin Orthop Relat Res 1988; 227: 67–81.Google ScholarPubMed
Gibbons, KJ, Soloniuk, DS, Razack, N.Neurologic injury and patterns of sacral fractures. J Neurosurg 1990; 72(6):889–93.CrossRefGoogle Scholar
Routt, ML Jr, Falicov, A, Woodhouse, E, Schildhauer, T.Circumferential pelvic antishock sheeting: A temporary resuscitation aid. J Orthop Trauma 2006; (20):S3–6.CrossRefGoogle ScholarPubMed
O'Neill, PA, Rinna, J, Sclafani, S.Tornetta, P III.Angiographic findings in pelvic fractures. Clin Orthop Relat Res 1996 Aug;(329):60–7.CrossRefGoogle ScholarPubMed
Routt, ML Jr, Kregor, PJ, Simonian, PT, Mayo, KA.Early results of percutaneous iliosacral screws placed with the patient in the supine position. J Orthop Trauma 1995; 9(3):207–14.CrossRefGoogle ScholarPubMed
Hanson, PB, Milne, JC, Chapman, MW. Open fractures of the pelvis. Review of 43 cases. J Bone Joint Surg Br 1991; 73(2): 325–9.CrossRefGoogle ScholarPubMed
Jones, AL, Powell, JN, Kellam, JF, McCormack, RG, Dust, W, Wimmer, P.Open pelvic fractures. A multicenter retrospective analysis. Orthop Clin N Am 1997; 28(3):345–50.CrossRefGoogle ScholarPubMed
Perry, JF Jr.Pelvic open fractures. Clin Orthop Relat Res 1980; (151):41–5.Google ScholarPubMed
Richardson, JD, Harty, J, Amin, M, Flint, LM.Open pelvic fractures. J Trauma 1982; 22(7):533–8.CrossRefGoogle ScholarPubMed
Rothenberger, D, Velasco, R, Strate, R, Fischer, RP, Perry, JF Jr.Open pelvic fracture: A lethal injury. J Trauma 1978; 18(3):184–7.CrossRefGoogle ScholarPubMed
Pell, M, Flynn, WJ Jr, Seibel, RW.Is colostomy always necessary in the treatment of open pelvic fractures?J Trauma 1998; 45(2): 371–3.CrossRefGoogle ScholarPubMed
Woods, RK, O'Keefe, G, Rhee, P, Routt, ML Jr, Maier, RV.Open pelvic fracture and fecal diversion. Arch Surg 1998; 133(3): 281–6.CrossRefGoogle ScholarPubMed
Copeland, CE, Mitchell, KA, Brumback, RJ, Gens, DR, Burgess, AR.Mortality in patients with bilateral femoral fractures. J Orthop Trauma 1998; 12(5):315–9.CrossRefGoogle ScholarPubMed
Nork, SE, Agel, J, Russell, GV, Mills, WJ, Holt, S, Routt, ML Jr.Mortality after reamed intramedullary nailing of bilateral femur fractures. Clin Orthop Relat Res 2003; (415):272–8.CrossRefGoogle ScholarPubMed
Bhandari, M, Zlowodzki, M, Tornetta, P, Schmidt, A, Templeman, DC.Intramedullary nailing following external fixation in femoral and tibial shaft fractures. J Orthop Trauma 2005; 19: 140–4.CrossRefGoogle ScholarPubMed
Bosse, MJ, MacKenzie, EJ, Kellam, JF, Burgess, AR, Webb, LX, Swiontkowski, MF, Sanders, RW, Jones, AL, McAndrew, MP, Patterson, BM, McCarthy, ML, Cyril, JK. A prospective evaluation of the clinical utility of the lower-extremity injury-severity scores. J Bone Joint Surg Am 2001; 83-A(1):3–14.CrossRefGoogle ScholarPubMed
Johansen, K, Daines, M, Howey, T, Helfet, D, Hansen, ST Jr.Objective criteria accurately predict amputation following lower extremity trauma. J Trauma 1990; 30(5):568–72.CrossRefGoogle ScholarPubMed
Lange, RH, Bach, AW, Hansen, ST Jr, Johansen, KH.Open tibial fractures with associated vascular injuries: Prognosis for limb salvage. J Trauma 1985; 25(3):203–8.CrossRefGoogle ScholarPubMed
Green, NE, Allen, BL. Vascular injuries associated with dislocation of the knee. J Bone Joint Surg Am 1977; 59(2):236–9.CrossRefGoogle ScholarPubMed
Treiman, GS, Yellin, AE, Weaver, FA, Wang, S, Ghalambor, N, Barlow, W, Snyder, B, Pentecost, MJ.Examination of the patient with a knee dislocation. The case for selective arteriography. Arch Surg 1992; 127(9):1056–62.CrossRefGoogle ScholarPubMed
Wascher, DC, Dvirnak, PC, DeCoster, TA. Knee dislocation: Initial assessment and implications for treatment. J Orthop Trauma 1997; 11(7):525–9.CrossRefGoogle ScholarPubMed
Mills, WJ, Barei, DP, McNair, P.The value of the ankle-brachial index for diagnosing arterial injury after knee dislocation: A prospective study. J Trauma 2004; 56(6):1261–5.CrossRefGoogle ScholarPubMed
McQueen, MM, Court-Brown, CM.Compartment monitoring in tibial fractures. The pressure threshold for decompression. J Bone Joint Surg Br 1996; 78(1):99–104.CrossRefGoogle ScholarPubMed
Gustilo, RB, Anderson, JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: Retrospective and prospective analyses. J Bone Joint Surg Am 1976; 58(4):453–8.CrossRefGoogle ScholarPubMed
Gustilo, RB, Mendoza, RM, Williams, DN. Problems in the management of type III (severe) open fractures: A new classification of type III open fractures. J Trauma 1984; 24(8):742–6.CrossRefGoogle ScholarPubMed
Sorger, JI, Kirk, PG, Ruhnke, CJ, Bjomson, SH, Levy, MS, Cockrin, J, Tang, P.Once daily, high dose versus divided, low dose gentamicin for open fractures. Clin Orthop Relat Res 1999; (366):197–204.CrossRefGoogle Scholar
Patzakis, MJ.Management of open fracture wounds. Instr Course Lect 1987; 36: 367–9.Google ScholarPubMed
Franklin, JL, Johnson, KD, Hansen, ST Jr.Immediate internal fixation of open ankle fractures. Report of thirty-eight cases treated with a standard protocol. J Bone Joint Surg Am 1984; 66(9): 1349–56.CrossRefGoogle ScholarPubMed
Moed, BR, Kellam, FJ, Foster, RJ, Tile, M, Hansen, ST Jr.Immediate internal fixation of open fractures of the diaphysis of the forearm. J Bone Joint Surg Am 1986; 68(7):1008–17.CrossRefGoogle ScholarPubMed
Fassler, PR, Swiontkowski, MF, Kilroy, AW, Routt, ML Jr.Injury of the sciatic nerve associated with acetabular fracture. J Bone Joint Surg Am 1993; 75(8):1157–66.CrossRefGoogle ScholarPubMed
Tornetta, P III, Mostafavi, HR.Hip dislocation: Current treatment regimens J Am Acad Orthop Surg 1997; 5(1):27–36.
Hawkins, LG.Fractures of the neck of the talus. J Bone Joint Surg Am 1970; 52(5):991–1002.CrossRefGoogle ScholarPubMed
Stuart, JM, Milford, LW.Fracture-dislocation of the hip: An end result study. J Bone Joint Surg 1954; 36A: 315–42.CrossRefGoogle Scholar
Yue, JJ, Wilber, JH, Lipuma, PJ, Murthi, A, Carter, JR, Marcus, RE, Valentz, R.Posterior hip dislocations: A cadaveric angiographic study. J Orthop Trauma 1996; 10(7):447–54.CrossRefGoogle ScholarPubMed
Jain, R, Koo, M, Kreder, HJ, Schemitsch, EH, Davey, JR, Mahomed, NN.Comparisons of early and delayed fixation of subcapital hip fractures in patients sixty years of age or less. J Bone Joint Surg Am 2002; 84-A(9):605–12.Google ScholarPubMed
Swiontkowski, MF, Winquist, RA, Hansen, ST Jr.Fractures of the femoral neck in patients between the ages of twelve and forty-nine years. J Bone Joint Surg Am 1984; 66(6):837–46.CrossRefGoogle ScholarPubMed
Carlson, DW, Rodman, GH Jr, Kaehr, D.Hage, J.Misinski, M.Femur fractures in chest-injured patients: Is reaming contraindicated?J Orthop Trauma 1998; 12(3):164–8.CrossRefGoogle ScholarPubMed
Dunham, CM, Bosse, MJ, Clancy, TV, Cole, FJ Jr, Knuth, T, Luchette, FA, Ostrum, R, Plaisier, B, Poka, A, Simon, RJ, and EAST Practice Management Guidelines Work Group. Practice management guidelines for the optimal timing of long-bone fractures stabilization in polytrauma patients: The EAST Practice Management Guidelines work group. J Trauma 2001; 50: 958–67.CrossRefGoogle ScholarPubMed
Gurd, AR, Wilson, RI.The fat embolism syndrome. J Bone Joint Surg Br 1974; 56B(3):408–16.CrossRefGoogle ScholarPubMed
Lindeque, BG, Schoeman, HS, Dommisse, GF, Boeyens, MC, Vlok, AL.Fat embolism and the fat embolism syndrome. A double-blind therapeutic study. J. Bone Joint Surg Br 1987; 69(1):128–31.CrossRefGoogle ScholarPubMed
Starr, AJ, Hunt, JL, Chason, DP, Reinert, CM, Walker, J.Treatment of femur fracture with associated head injury. J Orthop Trauma 1998; 12(1):38–45.CrossRefGoogle ScholarPubMed
Bhandari, M, Guyatt, GH, Kjera, V, Kulkarni, AV, Sprague, S, Schemitsch, EH.Operative management of lower extremity fractures in patients with head injuries. Clin Orthop Relat Res 2003; 407: 187–98.CrossRefGoogle Scholar
Poole, GV, Miller, JD, Agnew, SG, Griswold, JA.Lower extremity fracture fixation in head-injured patients. J. Trauma 1992; 32(5): 654–9.CrossRefGoogle ScholarPubMed
Zuckerman, JD, Skovron, ML, Koval, KJ, Aharonoff, GB, Frankel, VH.Postoperative complications and mortality associated with operative delay in older patients who have a fracture of the hip. J Bone Joint Surg Am 1995; 77(10):1551–6.CrossRefGoogle ScholarPubMed
Aharanoff, GB, Koval, KJ, Skovron, ML, Zuckerman, JD.Hip fractures in the elderly: predictors of one ear mortality. J Orthop Trauma 1997; 11(3):162–5.CrossRefGoogle Scholar
Cornwall, R, Gilbert, MS, Koval, KJ, Strauss, E, Siu, AL.Functional outcomes and mortality vary among different types of hip fractures: A function of patient characteristics. Clin Orthop Relat Res 2004; 425: 64–71.CrossRefGoogle Scholar
Endo, Y, Aharonoff, GB, Zuckerman, JD, Egol, KA, Koval, KJ. Gender differences in patients with hip fracture: A greater risk of morbidity and mortality in men. J Orthop Trauma 2005; 19(1): 29–35.CrossRefGoogle ScholarPubMed
Richmond, J.Aharonoff, GB, Zuckerman, JD, Koval, KJ. Mortality risk after hip fracture. J Orthop Trauma 2003; 17(1): 53–6.CrossRefGoogle ScholarPubMed
McLaughlin, MA, Orosz, GM, Magaziner, J, Hannan, EL, McGinn, T, Morrison, RS, Hochman, T, Koval, K, Gilbert, M, Siu, AL.Preoperative status and risk of complications in patients with hip fracture. J Gen Intern Med 2006; 21(3):219–25.CrossRefGoogle ScholarPubMed
Koval, KJ, Shovron, ML, Aharonoff, GB, Zuckerman, JD.Predictors of functional recovery after hip fracture. Effect of general versus regional anesthesia. Clin Orthop Relat Res 1998; 348: 37–41.CrossRefGoogle Scholar
Hoyt, DB, Junger, WG, Loomis, WH, Liu, FC.Effects of trauma on immune cell function: Impairment of intracellular calcium signaling. Shock 1994; 2: 23–8.CrossRefGoogle ScholarPubMed
Johansen, K, Lynch, K, Paun, M.Copass, M.Non-invasive vascular tests reliably exclude occult arterial trauma in injured extremities. J Trauma 1991; 31(4):515–9.CrossRefGoogle ScholarPubMed
Tucker, MC, Nork, SE, Simonian, PT, Routt, ML Jr.Simple anterior pelvic external fixation. J Trauma 2000; 49(6):989–94.CrossRefGoogle ScholarPubMed

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  • Musculoskeletal Trauma
    • By Heather A. Vallier, Department of Orthopedic Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, Mark D. Jenkins, Department of Orthopedic Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
  • Edited by Charles E. Smith, Case Western Reserve University, Ohio
  • Book: Trauma Anesthesia
  • Online publication: 18 January 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547447.018
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  • Musculoskeletal Trauma
    • By Heather A. Vallier, Department of Orthopedic Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, Mark D. Jenkins, Department of Orthopedic Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
  • Edited by Charles E. Smith, Case Western Reserve University, Ohio
  • Book: Trauma Anesthesia
  • Online publication: 18 January 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547447.018
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  • Musculoskeletal Trauma
    • By Heather A. Vallier, Department of Orthopedic Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, Mark D. Jenkins, Department of Orthopedic Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
  • Edited by Charles E. Smith, Case Western Reserve University, Ohio
  • Book: Trauma Anesthesia
  • Online publication: 18 January 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547447.018
Available formats
×