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Approach to the polytraumatized patient with musculoskeletal injuries

Section of Orthopaedic Traumatology, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore 21201, USA.

The management of the multiply injured patient is a challenge for even experienced clinicians. Because many community hospitals lack a dedicated trauma team, it is often the orthopaedic surgeon who will direct treatment. Therefore, the orthopaedic surgeon must have an understanding of established guidelines for the evaluation, resuscitation, and care of the severely injured patient. Initial evaluation encompasses assessment and intervention for airway, breathing, circulation, disability (neurologic injury), and environmental and exposure considerations. Resuscitation requires not only administration of fluids, blood, and blood products but also emergent management of pelvic trauma and stabilization of long-bone fractures. Judicious early use of anterior pelvic external fixation can be lifesaving in many cases. The secondary survey, which is often neglected, must incorporate a thorough physical evaluation. Although the method of fracture stabilization is still controversial, most clinicians agree that early fixation offers many benefits, including early mobilization, improved pulmonary toilet, decreased cardiovascular risk, and improved psychological well-being. Without an understanding of the complexities of the multiply injured patient, delays in the diagnosis and treatment of a patient's injuries are likely to adversely affect outcome.