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Related Concept Videos

Fractures: Bone Repair01:27

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Treatment for a fracture is based on the type of break, the bone affected, and the patient's age.
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the...
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Managing flail chest, a condition characterized by a segment of the chest wall moving independently from the rest of the thoracic cage, requires a comprehensive approach. It includes a thorough assessment of the patient's condition, a diagnostic evaluation to determine the extent of the injury, and the implementation of appropriate medical interventions tailored to the individual's needs.
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The vascular phase, also known as vasospasm, is the initial stage of hemostasis, crucial for preventing excessive bleeding when a blood vessel is injured. After a vessel is cut, nerves in the damaged area trigger pain and other sensory impulses. Simultaneously, the smooth muscles in the vessel wall contract, resulting in a vascular spasm. This contraction reduces the vessel's diameter at the injury site, slowing or stopping blood loss through the vessel wall. Vascular spasms typically last...
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Demystifying damage control in musculoskeletal trauma.

P Bates1, P Parker2, I McFadyen3

  • 1Barts Health NHS Trust , UK.

Annals of the Royal College of Surgeons of England
|March 30, 2016
PubMed
Summary

Early appropriate care, or safe definitive fracture surgery, is now recommended for most major trauma patients. This approach individualizes treatment based on patient response to resuscitation, optimizing outcomes in trauma fracture management.

Keywords:
Damage controlMajor traumaTemporary external fixation

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Area of Science:

  • Orthopaedic trauma surgery
  • Surgical critical care
  • Trauma resuscitation

Background:

  • Operative fracture management benefits major trauma patients.
  • Early total care concerns arose due to potential for 'second hit' phenomenon.
  • Damage control orthopaedics (DCO) was developed for critically injured patients.

Purpose of the Study:

  • To refine treatment options for major trauma patients based on physiological response.
  • To advocate for individualized care in trauma fracture management.
  • To introduce the 'safe definitive fracture surgery' (SDFS) or 'early appropriate care' (EAC) approach.

Main Methods:

  • Review of large-scale retrospective data on fracture fixation timing.
  • Analysis of physiological responses to major trauma and surgical interventions.
  • Development of a training course for senior surgeons on DCO and EAC principles.

Main Results:

  • Retrospective reviews suggest early definitive fixation benefits most major trauma patients.
  • Patient selection based on resuscitation response is crucial for optimal outcomes.
  • EAC/SDFS aims to provide individualized, timely fracture care.

Conclusions:

  • Refined understanding of trauma response necessitates individualized treatment strategies.
  • Appropriate patient selection is key to successful early definitive fracture fixation.
  • The DCO course equips surgeons with skills for DCO and EAC decision-making.