Management Of Extremity Injuries Research Articles

Current updates in management of extremity injuries in polytrauma

Injury-related morbidity and mortality have been one of the most common causes of loss in productivity across all geographic distributions. It remains to be a global concern despite a continual improvement in regional and national safety policies. The establishment of trauma care systems and advancements in diagnostics and management have improved the overall survival of severely injured. A better understanding of the physiopathological and immunological responses to injury led to a significant shift in trauma care from “Early Total Care” to “Damage Control Orthopedics.” While most of these algorithms were tailored to the philosophy of “life before limb,” the impact of improper fracture management on disability and societal loss is increasingly being recognized. Recently, “Early Appropriate Care” of extremities has gained importance; however, its implementation is influenced by regional health care policies, available resources, and expertise and varies between low and high-income countries. A review of the literature was performed using PubMed, Embase, Web of Science, and Scopus databases on articles published from 1990 to 2020 using the Mesh terms “Polytrauma,” “Multiple Trauma,” and “Fractures.” This review aims to consolidate on guidelines and available evidence in the management of extremity injuries in a polytraumatized patient to achieve better clinical outcomes of these severely injured.

Management of Extremity Injuries by Residents: Can We improve Quality and Efficiency through a Simple Checklist?

ABSTRACT Introduction Variation in practice among resident physicians is a barrier to providing consistent, high-quality care to patients with musculoskeletal injuries. Materials and methods A multidisciplinary group at an academic center developed a checklist for managing suspected extremity injuries in adults. Simulation testing was conducted in which 17 Emergency Medicine residents were randomized by year of training into cohorts of 8 “checklist” residents and 9 “no checklist” residents. Each resident performed 2 case simulations and was evaluated based on adherence to 12 predefined critical process measures. Results Usage of the checklist resulted in a decrease in delay of care events (8.3 vs 27.3%, p < 0.01) and decrease in potential medical errors (5.7 vs 22.2%, p < 0.01). All levels of training demonstrated improvements, and first-year residents using the checklist performed significantly better than third-year residents without the checklist, demonstrating decrease in delay of care events (8.3 vs 26.4%, p < 0.05) and decrease in potential medical errors (5.6 vs 18.1%, p < 0.05). Conclusion Implementation of a simple checklist can reduce delays in care and potential medical errors in the management of extremity injuries by resident physicians. Hamid KS, Nwachukwu BU, Nicks BA, Dutta S, Carroll EA. Management of Extremity Injuries by Residents: Can We improve Quality and Efficiency through a Simple Checklist? The Duke Orthop J 2016;6(1):7-11. IRB statement This simulation was undertaken as part of an institutional quality improvement project and was granted Institutional Review Board exemption.

Introduction

Introduction

Gunshot Wounds below the Popliteal Fossa: A Contemporary Review

The management of extremity injuries above the knee has been well described, but the evaluation and treatment guidelines for penetrating injuries below the popliteal crease has received less attention. A 6-year retrospective review of 100 patients who sustained isolated below-knee gunshot wounds. Patients with proximal extremity, torso, or head wounds were excluded from review so that we could focus on principles of managing below-knee wounds. All patients were evaluated with complete physical examination, ankle-brachial index, and plain X-rays. One patient presented with hemodynamic instability. Twenty-four patients underwent arteriography based on physical examination, an ankle-brachial index less than 0.9, or both. Twenty-two vascular injuries were identified in 19 patients, and an additional injury was found in a patient who went directly to surgery for pulsatile bleeding. Six of these 22 vascular injuries required treatment for bleeding or arteriovenous fistula. Treatment was by embolization in 5 and surgical ligation in 1. Thirteen patients had compartment syndromes. Thirty-five patients had fractures, and ten (29%) of these had an associated vascular injury. Four patients had peroneal nerve injuries, and three of these had long term disability. No limb loss or death occurred. We conclude that patients with low-velocity below-knee gunshot wounds sustain fractures, vascular injuries, compartment syndromes, and nerve injuries, in decreasing order of frequency. Arteriography and embolization may be useful to control bleeding; vascular reconstruction was unnecessary in our experience, and limb loss did not occur.

021. Management of Extremity Injuries in Extreme Circumstances

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Management of Extremity Injuries with External Fixator or Ilizarov Devices

Major advances in the last decade have improved the treatment and outcome of patients with moderate to severe lower extremity injuries. Better transport and emergency room facilities, which allow more prompt repair of injuries, advances in bone stabilization, and better methods of soft-tissue reconstruction have led to a significant decrease in amputation and infection rates. This article presents the Mangled Extremity Severity Score (MESS) index and Gustilo's classification to evaluate injuries. Orthopedic, plastic, and vascular surgeons collaborate to manage these injuries in five categories: limb viability, timing, debridement, fixation, and secondary reconstruction. Finally, two cases are presented to demonstrate practical application of these steps, and guiding principles are outlined.