Multiply Injured Research Articles

Is the Treatment of the Most Severe Multiply Injured Patients Worth the Effort?—A Followup Examination 5 to 20 Years after Severe Multiple Injury

Ninety-two most severely injured patients--with injuries to at least four body regions with a mean ISS of 39--were examined at the outpatient clinic 5 to 20 years after the trauma. In addition, nine patients were interviewed by phone, thus 92.6% of the patients still alive were contacted. Of those who were not retired before the injury 59 of 82 (72%) had been able to return to work and most of them were still working at the time of the followup. The main reasons for inability to work were brain and spinal cord injuries, blindness, and 'failure in re-education.' Most complaints arose from sequelae of brain, pelvic, and upper and lower extremity injuries. Only seven patients needed constant medication because of their injuries. We conclude that the treatment of even the most severely injured patients with multiple injuries is certainly worth the effort.

External Fixation in Multiply Injured Children

External fixation treatment for selected fractures can be as readily applied to children as to adults, although only a small percentage of pediatric fractures require this method. The best situations for the use of external fixation in children are in cases of multiple organ system injuries and in fractures associated with skin loss or large wounds. In these situations, while the child's other problems are being treated, external fixation provides excellent temporary stabilization to facilitate fracture management.

New Frontiers in the Management of the Multiply Injured Patient

This article describes current theories and technological advances in trauma management. The technologies are constantly changing, with new therapeutic modalities on the horizon. As approaches to trauma patient care become more complex, it remains a challenge and a requirement to remain abreast of current theories and practices in the field of traumatology.

Care of the Multiply Injured Patient With Cervical Spine Injury

Cervical spine injuries can be disastrous. The treatment begins at the accident scene by obtaining an appropriate history, physical examination, and evaluation of the mechanics of the accident. Emergency medical stabilization takes precedence, but the cervical spine should be stabilized until an injury in this area is ruled out. If the patient has suffered a head injury or is violent, cervical spine precautions should be maintained until spinal column injuries have been ruled out roentgenographically. Because of the complexities of the evaluation and treatment of cervical spine injury in the multiply injured patient, an algorithm to assist in the management and evaluation of the patient has been developed, and a multidisciplinary, specialized evaluation and treatment team is employed. Through this approach, mortality in the multiply injured patient with a cervical spine injury has been reduced to 22%. Of 58 patients with cervical spine injuries evaluated by this aggressive approach, 14 patients had associated spine fractures, and 9 patients had positive peritoneal lavage requiring surgical exploration. Injuries involving other organ systems were also diagnosed and treated. Formal, rigid evaluation plans and aggressive multidisciplinary treatment are useful in saving the lives and salvaging neurologic function of these patients.

Concurrent Oral Surgery and Orthopaedic Treatment in the Multiply Injured Patient

Fifty-five patients requiring oral surgery and orthopaedic care were studied prospectively and compared to a control group. Six patients received no antibiotics and one developed an orthopaedic operative site infection due to a mouth organism. Seventeen patients had concurrent surgery and perioperative antibiotic usage and no infections occurred. Twenty-six patients required multiple operations and courses of antibiotic treatment and five developed infections. Enterobacter infections were common and emerge because they are resistant to first-generation cephalosporins. Treatment by a perioperative first-generation cephalosporin is recommended, followed by throat cultures and treatment by antibiotics specific for cultured organisms for patients requiring subsequent operations.

Book Review: The Multiply Injured Patient with Complex Fractures

Book Review: The Multiply Injured Patient with Complex Fractures

Surgery in the Multiply Injured Patient

Surgery in the Multiply Injured Patient

The Multiply Injured Patient with Complex Fractures.

The Multiply Injured Patient with Complex Fractures.

Resuscitation of the Multiply Injured Patient

The resuscitation of the traumatized patient with multisystem injuries begins on the scene of the incident, continues into the emergency department, and finally includes the surgeon and the operating room. Treatment of the traumatized patient requires a systematic approach to best utilize all facilities and personnel while limiting duplication of service. The patient must go to the facility that best meets his or her needs. Stabilization in the emergency department should proceed in an orderly and organized fashion. Care must be taken when establishing the airway to protect the cervical spine. Massive hemothorax, tension pneumothorax, cardiac tamponade, intraabdominal bleeding, and retroperitoneal bleeding, as well as flail chest, must be remedied before stabilization and resuscitation can come to a successful outcome. Internal cardiac massage may need to be done for cardiac tamponade or when resuscitation has failed. Fluid repletion must be vigorous and aggressive. Albumin is probably of no benefit to the patient and, in fact, may be deleterious. Hetastarch may turn out to be a valuable addition to the fluid management of these patients. The patient is entitled to one physician who can call the consultants together. In addition, there should be a single physician for the patient who can control the timing of operative intervention as well as coordinate the overall management by the consultants.

Diagnosis and Management of Fractures in the Multiply Injured Patient

Careful and frequent examination of the patient is critical to the success of treating the multiply injured patient. Many "occult" fractures are often missed initially because attention is focused on major, life-threatening injuries. It is essential that the various specialists treating the multiply injured patient communicate effectively among one another regarding priorities and proposed therapies. If one service anticipates operative management of a specific injury, it may be coordinated with orthopedic needs, fracture fixation, or reduction being carried out simultaneously. No patient should have orthopedic problems managed by benign neglect, even if the probability of survival is low. Many tragically injured patients do not survive the initial hours following an accident because of massive abdominal or intrathoracic injury. However, orthopedic management in all patients should be based on the assumption that the individual will survive. Maximum functional recovery should be expected in those who do survive, and thus necessitates careful planning of fracture treatment acutely and chronically.

The Multiply Injured Patient—The Orthopedic Clinics of North America, Vol 1, No 1

Journal Article The Multiply Injured Patient—The Orthopedic Clinics of North America, Vol 1, No 1 Get access The Multiply Injured Patient—The Orthopedic Clinics of North America, Vol 1, No 1. Edited by Harvey JP. Philadelphia, W. B. Saunders Co., 1970, cloth, 189 pp, $22.50 Jacqueline King Jacqueline King Search for other works by this author on: Oxford Academic Google Scholar Physical Therapy, Volume 51, Issue 9, September 1971, Pages 1058–1059, https://doi.org/10.1093/ptj/51.9.1058a Published: 01 September 1971

Spinal Injuries in the Multiply Injured Patient

Summary 1. The presence of multiple injuries does not change the basic management of each injury but does impose the need for careful planning of treatment priorities. 2. Emergency care must be directed toward preservation of life without aggravation of neurological injury posed by spinal trauma. 3. Care of the associated injuries must be planned so as not to jeopardize rehabilitation of the paralyzed patient.

Genitourinary Injuries in the Multiply Injured Patient

Summary General principles for the recognition and treatment of acute blunt trauma of the urinary tract as seen in the multiply injured patient are presented. It is apparent from the discussion that the most severe disability results from injury to the male membranous-prostatic urethra. Details of the operative management for the various lesions are presented. The delayed complications listed make it quite obvious that follow-up is very important. Patients with urethral injury have to be observed for evidence of obstruction and infection. They require follow-up intravenous urography and should have the blood pressure checked periodically over the following year.

Thoracic Injuries in the Multiply Injured Patient

Summary Management of the patient who has sustained trauma to multiple systems dictates that first consideration be given to safeguarding his life. Fortunately, serious chest injury occurs in only about 10 per cent of seriously injured patients. When present, impairment of pulmonary ventilation requires immediate definitive treatment, which must be initiated by the physician who first sees the patient.

Peripheral Nerve Injuries in the Multiply Injured Patient

Peripheral nerve injuries in the multiply injured patient may be divided for discussion into two large groups according to the dominant injury: lesions accompanying visceral injuries and lesions complicating fractures and dislocations. In the case of visceral injuries, peripheral nerves are uncommonly involved in abdominal and chest lesions, but such involvement is seen occasionally in pelvic injuries and frequently in head injuries. The serious complication in head injuries involves the brachial plexus because the damaging source has obviously implicated the head and neck and may have extended to the plexus zone. For these reasons constant vigilance and assessment is necessary in all head injuries for this type of complication. The serious peripheral nerve complications in limbs follow fractures that have been sustained with more than the usual type of violence. In the upper limb the extensive injuries are seen with fractures of the medial third of the clavicle and segmental joint fractures of the sport's car elbow type. A complication to be constantly guarded against in forearm injuries is the Volkmann lesion, which should be watched for particularly in crush injuries in the upper third of the forearm. In the lower limb, force of even greater violence often has been involved to produce fractures of these much heavier bones, but this is not as common an occurrence so that the nerve complications are not as frequent. The heavy bony core and abundant soft tissue are the prime protectors. Fracture dislocations of the hip and shatter fractures of the upper third of the femur more often than not require exploration of the sciatic nerve. Perhaps the most serious injury involves the knee joint and in particular the upper third of the tibia. Treatment of the vascular complications overshadows nerve management in this instance. However, it is essential to obtain stability of the fracture as early as possible to prevent continuing traction damage to the nerves. Because of the bursting effect of shatter fractures in the upper third of the tibia the nerve complications almost always require surgical intervention. In the region of the ankle the fracture dislocation involving the talus should always be suspected of having damaged the posterior tibial nerve. Particularly careful search is required to identify the lesion.

Evaluation and Diagnosis in the Multiply Injured Patient

Evaluation and Diagnosis in the Multiply Injured Patient