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
osteoporosis.
Treatment – Difficult. Physiotherapy. Autonomic nerve blocks. Psychological support.
Rehabilitation – Rehabilitation is difficult. May ultimately lead to amputation of limb.