Pediatric trauma is the leading cause of death and permanent disability for children in the United States. As is true in the medical care of children, the treatment of the injured child is different than for an injured adult. Although the principles of trauma care are the same for children as for adults, the differences in care for pediatric trauma patients requires special knowledge, careful management,…
Acute traumatic injuries of the airway are rare, but lethal if not adequately assessed or managed. Acute airway injuries occur via blunt force trauma or penetrating injury. Most blunt force traumas occur from motor vehicle accidents but are closely followed by sport-related trauma and domestic violence. Penetrating traumas are predominantly due to gunshot or stab wounds. Following an acute airway trauma, a timely airway intervention becomes…
Over 50% of hospitalized trauma patients have one or more life- or limb-threatening musculoskeletal injuries. Among adolescent and adult trauma patients, extremity injuries are the most frequent type of musculoskeletal injury and the leading cause of trauma admission. Traumatic musculoskeletal injuries frequently involve complex bone and soft tissue defects requiring reconstruction to minimize future functional impairment. The severity of musculoskeletal injuries relates directly to the amount…
Finger and extremity replantation may perhaps be the most essential and challenging components of emergency hand surgery that is treated by a hand surgeon today. Microvascular surgery has revolutionized the field of emergency hand surgery in the areas of replantation and microvascular transplantation. The advent of supermicrosurgery—anastomosis of vessels less than 0.8 mm in diameter—has broadened the scope of replantation. Amputated parts as small as a…
Scapulothoracic dissociation Scapulothoracic dissociation (SD) is the traumatic disruption of the shoulder from the chest wall. It is characterized by a complete loss of scapulothoracic articulation, typically with intact skin, but may also present as an open injury with severe disruption of the overlying soft tissue ( Fig. 1 ) Vascular and neurologic injuries are common and in some cases result in what is essentially a…
Distal radius fractures Distal radius fractures are among the most common orthopedic injuries, accounting for one-sixth of all fractures seen in the emergency department (ED). As in many orthopedic injuries, there is a bimodal distribution pattern of patients presenting with this injury. Younger patients, 18 to 25 years old, often have a higher-energy injury such as motor vehicle accident or fall from height while older patients,…
Fractures of the pelvic ring represent an important injury of the traumatized patient with a vast range of injury patterns and treatment options. The incidence of pelvic ring injuries is between 2% and 8% with a frequency as high as 25% in the polytrauma cohort. A bimodal distribution exists with high-energy unstable fractures more common in young males and low-energy stable fractures more common in elderly…
Approximately 3% to 4% of patients with blunt trauma in the emergency department sustain a spinal column injury, such as spinal fracture or dislocation, while 1% sustains a spinal cord injury. The incidence is higher in unconscious patients and those with associated head trauma. The most common cause of spinal column injuries is motor vehicle accidents (45%), followed by falls (20%), sports-related accidents (15%), violence (15%),…
Severe injuries of the lower extremity are a life-changing event that are usually the result of high-impact trauma, such as motor vehicle accidents and crush injuries. Initial resuscitation, diagnostic evaluation, and management of trauma patients with blunt or penetrating trauma are based on protocols from the Advanced Trauma Life Support (ATLS). Life-threatening injuries to head, neck, chest, or abdomen should take precedence over the extremity injury.…
Fractures and dislocations of the upper extremity can range from benign problems requiring minimal intervention to life- or limb-threatening emergencies. Treatment considerations include injury pattern, mechanism, status of the soft tissues, associated neurologic or vascular injury, and other bodily injuries. We will first discuss key issues in the decision-making process in treatment of upper extremity injuries, then focus on specific injuries and their treatment. Open fractures…
Most cervical, truncal, and peripheral vascular injuries can be treated using simple techniques of repair performed by general, trauma, or vascular surgeons. Certain locations of injury and complex injuries, however, mandate more advanced techniques of exposure and innovative operative approaches to save the patient’s limb and even his or her life. Although temporary intraluminal vascular shunts are occasionally used with selected cervical and truncal vascular injuries,…
Penetrating arteriovenous fistulas (AVFs) are a rare complication of vascular injuries; consequently, few trauma surgeons and trauma centers have significant experience with their management. Most series have been reported during wartime and/or prior to the advent of well-developed vascular surgical techniques and instruments. Penetrating injuries may involve both the arteries and veins in close proximity, resulting in an anomalous connection between the two vessels—otherwise defined as…
Vascular injuries in branch vessels of the popliteal artery such as the tibioperoneal trunk and shank vessels such as anterior, posterior tibial, and peroneal vessels occur with variable frequency in both blunt and penetrating trauma. While their management has evolved significantly in the past few decades, limb loss and morbidity remain significant. Historical perspective During World War I, ligation of injured vessels below the knee was…
Historical perspective In 1906, José Goyanes from Spain first resected a traumatic popliteal artery aneurysm and used the adjacent popliteal vein to reconstruct the popliteal artery with an interposition graft. He is thus credited with the description of the first autogenous reverse saphenous vein graft. Any further discussion of popliteal vessel injuries should commence by reviewing the knowledge acquired in the management of battlefield injuries. These…
Anatomy The femoral artery is a direct continuation of the external iliac artery, which courses from the inguinal ligament to the adductor canal (subsartorial or Hunter’s canal), where it exits as the popliteal artery. The common femoral artery lies at a point midway between the anterior superior iliac spine and the pubic symphysis. Proximally, the femoral vessels course through the femoral triangle, the borders of which…
Injury to the iliac vessels poses a serious and frustrating treatment dilemma for all trauma surgeons. Throughout both civilian and military history injuries to the iliac vessels have been devastating, due to the often uncontrollable hemorrhage and severe associated injuries that accompany them. Generally, patients present in profound shock secondary to severe hemorrhage from either iliac arterial, venous, or combined injuries. The associated problems and injuries…
Reports of arterial injuries from both the civilian and military arenas report the brachial artery as the most frequently injured vessel, accounting for approximately 25% to 33% of all peripheral arterial injuries. The frequency of injury is similar in some reports to that of the superficial femoral artery as both arteries are long and located in vulnerable positions in their respective extremities. Experiences from both the…
Axillary vessel injuries are uncommon and challenging injuries encountered by trauma surgeons. Proximity of this vessel to other adjacent veins including the axillary vein, brachial plexus, and the osseous structures of the shoulder and upper arm account for a large number of associated injuries. Hemorrhage from the axillary vessels and particularly from the axillary artery can be torrential and may lead to exsanguination if uncontrolled. This…
Thoracic and thoracic-related vascular injuries represent complex challenges for the trauma surgeon. Subclavian vessel injuries, in particular, are uncommon and highly lethal. Regardless of the mechanism, such injuries can result in significant morbidity and frequent fatality. Subclavian vessel injuries are generally associated with multiple life-threatening injuries. Over the years, the overall mortality rate has continued to improve as a result of significant advancements in resuscitation, emergency…
Background Penetrating vertebral artery injuries (VAIs) are rare, difficult to diagnose, and pose a challenge to surgeons, given their complex anatomy and difficult surgical exposure. Due to the rarity of these injuries, few surgeons and trauma centers have developed a significant experience with their management. Matas in 1893 reported 53 patients collected from the literature, which he divided into: endocranial aneurysms, 11; extracranial cerebral aneurysms, 20;…