Trauma definition

Injurious application of force or physical agent (heat, cold) or chemical agent.



General effects  –   depending on the degree of injury

tissue damage.             –            Pathology of cellular injury.

cardiovascular shock   –           Low bp, tachycardia

respiratory                     –           ARDS (shock lung) – tachypnoea

visceral injury               –           abdominal pain, tenderness and guarding

multiple organ failure     –       renal, cardiac and hepatic failure


Localised trauma – effects

skin      –           skin loss,  infection, fluid loss

joint      –          ligament injury, bone injury, dislocation

bone      –         fractures  –   management principles below

nerves   –         neuropraxia, axontmesis, neurotmesis

muscle and tendon –    contusion,  avulsion,  tear


Chronic strain syndromes

bone                –          stress fracture

cartilage          –          deterioration

tendon             –          tendonitis

bursae             –           bursitis

RSD syndromes –      causalgia, shoulder hand, etc.


Trauma Management  –  Initial Principles 

General                                       –           Airway   Breathing  Circulation


Treatment of bony injuries–           resuscitation, assessment, reduction, fixation, graft

( NB Fractures represent a failure of the bone to support its load.  In this respect a fracture is a relative event – force vs. strength of bone. Degree of comminution represents the degree of force applied. )

Treatment of soft tissues      –           Repair by suture, grafting, (muscle and tendon) transfer

Rehabilitation                            –          Active and passive – restore function



Definitive Principles of Management of Injuries

Fractures –             Break in continuity of bone.  Described as ‘simple’, ‘comminuted’, ‘compound’.

Symptoms   –             History of injury,  pain aggravated by movement, consequent loss of function.

Signs            –             Deformity local swelling,  bone tenderness,  abnormal bone movement, crepitus,   later bruising

Treatment   –            Non-operative          –             Reduction. Immobilization. Rehabilitation

Operative                  –             Open reduction. Fixation with implant.  Tissue engineering. Rehabilitation


Dislocations   –      Dissociation of a joint varies from mild incongruity (subluxation) to complete dissociation (dislocation)

Symptoms         –      History of injury,  pain,  loss of function

 Signs                   –     Local swelling, tenderness,  deformity with abnormal joint contours and landmarks, limited movement

Treatment         –     Non-operative      –         Reduction. Immobilization. Rehabilitation.

Operative               –      Open reduction and ligament repair.  Rehabilitation.


Ligament injury      –      Ligament injury on a continuum of scale of injury from being merely stretched to being

completely torn.  If ligament intact termed a  SPRAIN. If ligament torn termed a  RUPTURE.

Determined by ‘end point’ of ligament on stressing.

Symptoms                    –     History of injury,  pain aggravated by activity,  consequent loss of function

Signs                              –     Local swelling,  ligament tenderness,  abnormal joint laxity, the ‘gap’ sign in larger ligaments,

later bruisin

Treatment                     –    Non-operative    –    rest and support then mobilization. Rehabilitation

Operative            –    suture, transplant, tissue engineering.   Rehabilitation


Chronic  Repetitive  Strain Syndromes

Stress fractures

Symptoms      –       Bone pain without obvious injury.

Signs                –       Localized pain and tenderness along bone, typically metatarsal or tibia. Loss of function.

Bone scan ‘hot’.

(X-ray initially normal, later fracture line and sclerosis.)

Treatment      –      Treated initially with rest. Electromagnetism? Surgery if no healing.


Tendonitis     –    Inflammation in tendon sheath.

Symptoms        –     Pain and tenderness along tendon aggravated by movement.

(Typically at wrist (De Quervain’s) and ankle (Tendo Achilles).

Findings             –     Pain. Thickening of tendon sheath. Crepitus.

Treated             –     anti-inflamatories,  physiotherapy, local steroid injection into tendon sheath, surgical release of sheath.


Enthesitis       –    Inflammation affecting Sharpey’s fibres at muscle and tendon origins. (Typically at elbow and hip).

Symptoms        –    Localised pain aggravated by movement.

Findings            –    Localised tenderness at musculo-tendinous origin.

Treated             –    anti-inflammatories,  physiotherapy, local steroid injection into tendon sheath, surgical release


Bursitis            –   Inflammation in the bursae between skin, tendon, fascia, muscle and bone. (Typically at hip and knee).

Symptoms         –   Localised pain over the joint or bony prominence, aggravated by movement.

Findings             –   Localised thickening and tenderness.

Treated              –   anti-inflammatories,  physiotherapy, local steroid injection into tendon sheath, surgical release


Reflex Sympathetic Dystrophies (RSD)

Symptoms          –     Severe pain in the affected area.  Marked loss of                                             function.

Signs                   –      Swelling and oedema affecting the whole area. Marked generalised tenderness,  Blotchy, cyanotic

discoloration of skin. Usually sweaty. Marked loss of function. X-rays show progressive, patchy


Treatment         –      Difficult. Physiotherapy. Autonomic nerve blocks. Psychological support.

Rehabilitation   –     Rehabilitation is difficult. May ultimately lead to amputation of limb.