Management of Musculoskeletal Injuries in the Trauma Patient PDF
Preview Management of Musculoskeletal Injuries in the Trauma Patient
Wade R. Smith Philip F. Stahel Editors Management of Musculoskeletal Injuries in the Trauma Patient 123 Management of Musculoskeletal Injuries in the Trauma Patient Wade R. Smith (cid:129) Philip F. Stahel Editors Management of Musculoskeletal Injuries in the Trauma Patient Editors Wade R. Smith , MD, FACS Philip F. Stahel, MD, FACS Department of Orthopaedics Department of Orthopaedics Swedish Medical Center Denver Health Medical Center Englewood , CO and University of Colorado USA School of Medicine Denver , CO USA ISBN 978-1-4614-8550-6 ISBN 978-1-4614-8551-3 (eBook) DOI 10.1007/978-1-4614-8551-3 Springer New York Heidelberg Dordrecht London Library of Congress Control Number: 2013954367 © Springer Science+Business Media New York 2014 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifi cally for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher's location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) This book is a tribute to Otmar Trentz , MD , a European pioneer of the “Acute Care Surgery” model in the 1980s and 1990s. Otmar Trentz represents the prototype of a dedicated academic trauma surgeon and passionate teacher and advocate for the integrated care of the trauma patient with associated musculoskeletal injuries. Born in Trier, Germany, in 1942, Otmar Trentz graduated from Medical School at the University of Würzburg in 1967. After residency in Würzburg and Hannover, he was board certifi ed in general surgery in 1974. Dr. Trentz then joined Harald Tscherne’s renowned “Hannover School” as an attending trauma surgeon. In 1980, at the young age of 38 years, he was elected as the director of trauma surgery at the Hannover Nordstadt Hospital. From 1983 to 1990, Otmar Trentz was the chairman of the Department of Trauma Surgery and professor of surgery at the University Hospital of Homburg/Saar. In 1990, he was elected as chairman and professor of trauma surgery at the University of Zurich, Switzerland. Under Otmar Trentz’s leadership, the University Hospital Zurich grew to one of the nationally and internationally renowned “premier” academic level 1 trauma centers in Europe. Some of the seminal achievements of Professor Trentz’s tenure in Zurich from 1990 to 2008 include the implementation of an integrated approach to the care of the multiply injured patient and the introduction of the fi rst ATLS course in Switzerland in 1999. His research focus was centered on the pathophysiology of shock, polytrauma, and the pathogenesis of “host defense failure” in multiply injured patients. Otmar Trentz’s scientifi c oeuvre encompasses more than 300 peer-reviewed publications in the pertinent trauma literature. He is furthermore the editor of multiple textbooks in the fi eld of general surgery and trauma surgery, including the encompassing work entitled “Unfallchirurgie” which represents the “bible” for all trauma surgeons in German- speaking countries. Otmar Trentz is furthermore the Editor Emeritus of the European Journal of Trauma and Emergency Surgery . Today, at the respectful age of 71 years, Professor Trentz continues to work as a consulting surgeon at the Madras Institute of Orthopaedics and Traumatology (MIOT) in Chennai, India, where he performs about 100–120 surgical procedures per month. Beyond a doubt, Otmar Trentz’s legacy as a charismatic, passionate, modest, and endlessly hardworking pioneer in the fi eld of trauma surgery will endure in the generations of European trauma surgeons whom he mentored during the “golden years” in Hannover and Zurich . Otmar Trentz Foreword: The Master’s Perspective This comprehensive textbook provides a timely, integrated view on the impact of musculoskeletal injuries in the multiply injured patient and provides the rationale for coordinated interdisciplinary care. In contrast to isolated orthopedic injuries, which are managed by most general orthopedists with interest in fracture care, the polytraumatized patient requires a distinct, custom-tailored approach related to the optimal timing and modality of frac- ture fi xation. The book is authored by trauma-trained, dedicated surgeons who recognize this critical distinction. Clearly, polytrauma represents more than just the sum of all individual injuries. The complex underlying patho- physiology renders multiply injured patients vulnerable to an uncoordinated fragmentation of care by individual specialists, which ultimately results in suboptimal patient outcomes. More than a century ago, the father of modern medicine, Sir William Osler (1849–1919), stated that “Specialism has frag- mented the specialties themselves in a way that makes the outlook hazardous.” Management of Musculoskeletal Injuries in the Trauma Patient provides a unique perspective of coordinated trauma care, which takes into account the fundamental concept that specifi c orthopedic injuries have a dramatic impact on the systemic pathophysiology of major trauma. For example, a fractured femur aggravates the systemic burden to the pulmonary endothelium and the blood-brain barrier through release of infl ammatory mediators, including fat embolism syndrome. Patients with chest contusions and/or head injuries are therefore more vulnerable to secondary organ failure (ARDS, brain edema), unless femur fractures are stabilized in a proactive fashion through multidis- ciplinary damage control protocols. Similarly, patients with severe pelvic ring disruptions are at risk for exsanguinating hemorrhage and the acute coagulopathy of trauma unless early bleeding control is achieved by stan- dardized measures, including external pelvic fi xation and retroperitoneal packing. Such proactive protocols evolved from the “European model” which historically considered the integrated trauma team as the single s pecialist responsible for the care of critically injured patients. In the United States, this evolving model is refl ected by the civilian acute care surgeon and the military combat trauma surgeon. This book outlines the concept of optimized multidisciplinary care for trauma patients with orthopedic injuries in a logical and comprehensive fashion, with a focus on high-energy limb- and life-threatening injuries, extremes of age, and critical associated injuries to the head, spine, and torso. vii viii Foreword: The Master’s Perspective Both editors are renowned experts in integrated trauma care systems, with a track record of synergistic team building across the main disciplines involved in the care of the trauma patient (orthopedic surgery, trauma surgery, and neurosurgery). Unquestionably, the primary goal of the initial multidisci- plinary management of polytrauma is p atient survival . As trauma care has matured, the ultimate functional outcome of the patient has focused importance on the need for s tate - of - the - art orthopedic trauma care. This new textbook will hopefully contribute to a meaningful prioritization and optimization of the care of the injured patient with associated musculoskele- tal injuries and strengthen the bond between the responsible teams through improved communication and standardized interdisciplinary protocols. Denver, CO, USA Ernest E. Moore, MD, FACS Editor-in-Chief The Journal of Trauma and Acute Care Surgery Pref ace Management of Musculoskeletal Injuries in the Trauma Patient is a fi rst- edition textbook written in the multidisciplinary spirit of modern trauma care. The genesis of the project originated during a course at the annual American College of Surgeons meeting in Chicago entitled Orthopedic Trauma Emergencies . This symposium was aimed at a mixed audience of general, trauma, and military surgeons. The lecture hall was packed and the audience was primed with practical and highly sophisticated questions, which revealed the widespread interest in the overall management of musculoskel- etal injuries in trauma patients. During the ensuing discussion in and out of the lecture hall, we were impressed by the level of knowledge about muscu- loskeletal injuries of our non-orthopedic colleagues. We also became aware of how critical it was for on-call general and trauma surgeons to understand the modern advances in orthopedic trauma care in order to build better inte- grated trauma systems and to improve the daily collaboration with their orthopedic colleagues. Concomitantly, orthopedic surgeons articulated their need to understand the evolving rationale for treatment of chest, abdominal, brain, and vascular injuries in order to ensure a high-quality multidisciplinary approach to the care of the trauma patient. From these shared anecdotal expe- riences evolved a plan for a new textbook dedicated to the decision making of when and how to treat musculoskeletal injuries in the trauma patient. The book’s fi rst edition is organized into three sections based on the priori- ties of trauma care, specifi c injuries, and specialized approaches in the pres- ence of signifi cant associated injuries. While we recognize that a one-size-fi ts-all approach is not appropriate for the diverse fi eld of trauma care, we also maintain that a “do-it-different, every place, every day” attitude defi es logic with regard to the underlying principles of the pathophysiology of shock, organ failure, and death. Therefore, we have focused on the com- plex interplay of musculoskeletal injuries and their effect on optimized patient-centered care. Given that a prospective randomized study is not pos- sible for every clinical trauma question, we must apply data plus logic plus individual experience to formulate new treatment strategies aimed at reduc- ing error and improving outcomes. Toward that end, we are extremely privi- leged to have a selection of world-renowned authors with stellar reputation and outstanding experience. All authors are traumatologists in their respec- tive subspecialties who have devoted their lives and careers to the care of the injured patient. ix
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