Principles of Trauma

Abstract

Orthopedic trauma surgeons play a pivotal role in the management of trauma patients. It is important to keep in mind the ABC’s of the trauma primary survey: Airway, Breathing and Circulation during evaluation. The secondary survey includes a comprehensive and focused physical exam, often identifying extremity injuries. Life-saving measures should be initiated prior to limb-saving interventions. Often in the polytrauma patient, damage control orthopedics may be necessary. Damage control orthopedics consists of the stabilization of non-life-threatening orthopedic injuries until the patient is adequately resuscitated and optimized for definitive fixation. Traumatic injuries place a burden on society in terms of disability, lost income potential, and healthcare expenditures. Orthopedic trauma can be a versatile entity, consisting of high energy injuries, fragility fractures in elderly patients, and infections.

What class of shock and what percentage of total body blood loss are indicated by normal blood pressure with an elevated heart rate?	Class II Shock and loss of 15–30% blood volume
Transfusion of what blood products are indicated in a 1:1:1 ratio?	Red blood cells, platelets, plasma
What serum marker value is indicative of adequate resuscitation ?	Serum lactate levels <2 mmol/L
How much blood can be lost into the thigh from a single femur fracture ?	1–2 L
What Injury Severity Score (ISS) is considered a major trauma with >10% mortality?	An ISS of 15. ISS = sum of the squares of the three highest Abbreviated Injury Scores (AIS)
What should be done if pelvic instability is identified by exam and radiograph and the patient is hemodynamically unstable?	Placement of pelvic binder or clamped bedsheet centered around patient’s greater trochanters
What X-ray views can help better identify pelvic ring fractures?	Inlet and outlet views
What are the options of damage control orthopedics management of a long bone fracture ?	External fixation and skeletal traction
What radiographic finding is indicative of a scapulothoracic dissociation ?	Displacement of the edge of scapula from the spinous process by >1 cm from the contralateral side
Is lower extremity trauma an indication for internal fixation of an otherwise uncomplicated humeral shaft fracture ?	Yes