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Trauma Evaluation Priorities

• Saving lives through treating major abdominal and head injuries, pelvic fractures (difficult to assess bleeding), and saving extremities with vascular injuries or open fractures.
• Joint dislocations and fracture reduction are crucial.
• Initial assessment includes assessment and resuscitation, and applying trauma ABCDE (airway, breathing, circulation, disability, exposure).
• Tissues damaged in fractures include bone, periosteum, muscle, subcutaneous fat, and skin.
• Skin's importance as a primary barrier against infection.
• Muscles help with circulation.
• Periosteum, providing blood supply (outer layer), includes osteoprogenitor cells.
• Bone blood supply comes from arteries such as feeding, metaphyseal-epiphyseal and periosteal artery systems.
• Fractures, causing impaired bone integrity usually associated with soft tissue injury.
• Diagnosis via plain radiographs in two planes, at right angles to each other, with one view from above and below the joint.

Fracture Types

• Open fractures involve a fracture communicating with the external environment without a skin barrier.
• 3% of fractures in the extremities (femur or humerus) are open fractures.
• Rapid wound assessment and removal of contamination are necessary.
• Use sterile, moist, loose dressing for single use.
• Antibiotic treatment depends on the type of bacteria, e.g., Gram (+) use cephalosporins, Gram (-) use aminoglycosides, and contaminated wounds may require penicillin.

Fracture Findings

• Pain and tenderness
• Deformity
• Swelling
• Limited range of motion (ROM)
• Ecchymosis (bruising)
• Pathological motion

Tetanus Prophylaxis

• Tetanus toxoid is required.
• Individuals <5 years old generally do not need vaccination.
• Individuals > 5 years old should have a booster vaccination.
• No vaccine is required for individuals who have had a dose of tetanus vaccine in the past year.

Gustillo & Anderson Classification

• Type I: <1 cm
• Type II: 1-10 cm
• Type III: divided by the presence or absence of soft tissue coverage.
  • Type III-A: Adequate soft tissue coverage.
  • Type III-B: Inadequate soft tissue coverage. -Type III-C: Vascular injury requiring repair

Primary Surgery Fracture Fixations

• Plates, often used for upper extremity and metaphyseal fractures.
• Intramedullary (IM) nails might be used with or without reaming, especially for type 3B fractures.
• External fixators (EFs) are often the most common temporary or permanent fixation method.

Secondary Surgery Soft Tissue and Bone Tissue

• Soft-tissue transfer often happens as soon as possible (within 7 days).
• Types I, II, and III-A fractures may have primary closures.
• Type III-B fractures necessitate soft tissue transfer for proper bone closure.
• Internal fixation transition is key; defects are closed using bone transport or vascularized bone grafting (8–12 weeks).

Healing Phases

• Inflammation phase (1–4 days): fragments of devascularized tissue, macrophage/neutrophil action, clearing necrotic bone fragments, and formation of hematoma.
• Repair phase (2–40 days): primary callus response, angiogenesis, collagen fibers for loosely binding fragments, and endochondral ossification.
• Remodelling phase (25–100+) : bone returns to normal shape.

Factors Affecting Fracture Healing

• Age
• Chronic disease
• Vascular damages
• Smoking
• Nerve function
• Sterility (open fractures)

Soft Tissue Injuries

• 1st degree: microscopic structural damage, mild tenderness
• 2nd degree: Partial tissue rupture, swelling and tenderness.
• 3rd degree: Complete tissue rupture, significant swelling, and instability.

Ligament Injuries

• Bruising, swelling, tenderness, pain on movement/palpation, and instability, especially with significant injuries.
• MRI scans confirm diagnoses.

Strains

• First-degree: minimal strength/movement loss, pain on active/passive stretching.
• Second-/Third-degree: significant functional loss, severe pain exacerbated by muscle contraction, and potential palpable defects resembling tumors.

Contusions

• Caused by direct blows, causing bleeding within a muscle, muscle tears with heavy bleeding.

Intramuscular Hematoma

• Bleeding within muscle fascia, causing swelling and limited mobility.
• Damage may include fascia and adjacent blood vessels and/or bleeding between muscles.
• Swelling occurs slowly distally to the injury site within 24–48 hours.
• Muscle function often gradually improves.
• Treatment usually involves RICE (Rest, Ice, Compression, Elevation).

Cubitus Valgus/Varus and Genu Varum/Valgum

• These describe forearm and knee angulation issues.

Skeletal Alignment

• Specific grades describe the degree of misalignment and joint instability.

This quiz focuses on assessing priorities during trauma evaluations, highlighting critical interventions for major injuries and fractures. It covers essential evaluations such as airway management, circulation, and the impact of soft tissue injuries on bone health. Test your understanding of the complex interactions involved in trauma care.