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Polytrauma management - What is new and what is true in 2020 ?

H C Pape1, L Leenen2

  • 1Department of Trauma, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.

Journal of Clinical Orthopaedics and Trauma
|March 15, 2021
PubMed

Insights

This review examines advancements in polytrauma patient care before 2020, including evidence-based definitions, resuscitation strategies, and evolving fracture fixation protocols like Early Appropriate Care (EAC). It highlights key shifts in managing complex trauma patients.

Area of Science:

  • Trauma Surgery
  • Emergency Medicine
  • Orthopedic Surgery

Background:

  • Polytrauma management has evolved significantly, driven by the need for standardized definitions and evidence-based practices.
  • Early 21st-century trauma care saw advancements in understanding coagulopathy and resuscitation techniques.

Purpose of the Study:

  • To review critical changes in polytrauma management practices implemented before 2020.
  • To analyze the evolution of key treatment modalities including definition, resuscitation, and fracture fixation.

Main Methods:

  • Literature review focusing on changes in polytrauma treatment prior to 2020.
  • Analysis of five key areas: definition, Resuscitation Associated Coagulopathy (RAC), neutrophil-guided resuscitation, perioperative scoring, and fracture fixation strategies.

Main Results:

  • Development of an evidence-based definition for polytrauma.
  • Increased understanding and management strategies for Resuscitation Associated Coagulopathy (RAC).
  • Emergence of neutrophil-guided resuscitation and refined perioperative scoring systems.
  • Evolution of fracture fixation strategies, including Early Total Care (ETC), Damage Control Orthopedics (DCO), Early Appropriate Care (EAC), and Safe Definitive Surgery (SDS).

Conclusions:

  • Significant progress has been made in defining and managing polytrauma patients.
  • Treatment protocols have become more sophisticated, emphasizing early, evidence-based interventions.
  • The adoption of strategies like EAC and SDS reflects a move towards optimized patient outcomes in complex trauma care.

Keywords:
Damage control orthopedicsMultiple injuriesPolytraumaSafe definitive surgeryScoresSevere trauma

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