Specific aspects of the treatment of patients with multiple mechanical and burn injuries

Fewer than 5 percent of all burn patients sustain other traumatic injuries before, during, or immediately after their accident. Multiple traumas associated with a burn injury create special problems during the care of the thermally injured patients. Conversely, the burn injury often complicates the diagnosis and treatment of the trauma. The combination of mechanical and burn injuries can be divided into two types: a) any associated fracture located outside the burned area, or b) fractured bones within the burned area. This situation represents a critical factor which must be taken into account during treatment procedures. The following options should be considered: in fractures outside the burned area, there would be no difference in standard, skeletal treatment procedures. For the treatment of fractures in burned areas (mostly on the extremities), the optimal procedure is osteosynthesis within 48 hours of the burn trauma, when the burn wound is nearly sterile (without significant bacterial colonisation). We prefer two-team surgery. Firstly, a trauma surgeon performs osteosynthesis and, after that, burn surgeons treat the burns. The optimal approach in full-thickness burns would be necrectomy and autografting. This is, however, not always possible, because of the overall condition of the patient who has been continuously resuscitated during the shock period. All individual factors must be considered during the decision-making process.