Procedure 85 - Optimizing Perioperative Fracture Care

Abstract

Based on current literature, we will describe the perioperative principles and techniques that are most important in caring for injured patients, giving the orthopedic surgeon the tools to provide the best global care for his or her patients through a synthesis of the relevant information. The subjects addressed are Advanced Trauma Life Support (ATLS), initial care of the injured limb, thromboprophylaxis, antibioprophylaxis, psychological reaction to injury, head injury, and secondary prevention. The ATLS protocol should be used to evaluate any patient who sustains a moderate to high-energy injury; patients with a pelvis or femur fracture, a decreased level of consciousness or intoxication; and those with multiple injuries. Initial care of the injured limb may seem very straightforward; however, some key aspects can be overlooked. The essential steps to follow are adequate immobilization, sufficient pain management, and providing walking aids. Preventing venous thromboembolism is of first importance in the treatment of an orthopedic trauma patient. Physicians should also be aware that venous thromboembolism can increase in the presence of pelvic fractures or spine fractures with neurologic deficit. No definitive scientific evidence on antibioprophylaxis and tetanus prevention exists; however, a metaanalysis on hip fracture surgery concluded that the use of intravenous (IV) antibiotics reduces the risk of postoperative infection. It is important to identify patients with a psychological reaction to injury because psychological pathologies can interfere with patient collaboration in treatment regimens. Head injury can be classified as mild, moderate, or severe. Typically, classification is based on neurologic injury severity criteria; the most commonly used classification system is the 15-point Glasgow Coma Scale (GCS). Secondary prevention can prevent, interrupt, or minimize the progression of a disease or disorder at an early stage.