multi trauma patient upper limb injuries in … · (multiple severe) upper limb injuries in the...
TRANSCRIPT
(MULTIPLE SEVERE) UPPER LIMB INJURIES IN THE
MULTI TRAUMA PATIENT
George Cox - Consultant Upper Limb Surgeon
‘A fracture is a soft tissue injury which is complicated by a break in
the bony cortex’ Anon
Fractures!
WHAT ARE YOU TREATING?
FRACTURE TREATMENT
• Life• Soft tissues• Nerves• Blood vessels• Muscle (compartments)• Skin
• Bones / joints• Early Movement & Rehabilitation
SURGICAL TEAM
• Shared decision making• Combined operating• ‘Early total care’ vs ‘Damage control’• Close working with non-surgical team
SOFT TISSUES
• Compartments / Nerve / Vessel Injury• Be suspicious→ Early intervention
• Soft tissue coverage• Required for
internal fixation→ Plastic input
• Ex-fix?• Wrist – Yes!• Elbow / humerus
→ Radial nerve!
• ETC vs DC
OCCULT INJURIES
• Problems for the patient• Difficult to treat if
missed
• Problems for you • Claims
• Keep looking & Keep asking• X-ray all injured
parts
REHABILITATION
• ITU• Early therapist
intervention• Passive
movements
• Fixation for rehabilitation• UL fixation for LL?• Clavicle for chest?• Bilateral injuries?• Type of fixation?
CASE A
• 16 year old motorbike• Extensive open upper limb injuries • ’Do you need to amputate arm/arms?’
CASE A
• Early total care vs. Damage limitation?• → Damage limitation• Debridement / Span / Scan / Plan• Systemic / local resuscitation ITU
CASE B
• 77 year old motorbike• Isolated right arm injury• Open humerus / elbow / forearm / hand• Radial nerve palsy
CASE B
• Multiple open wounds but soft tissue (not skin) coverage possible
• Early total care vs. Damage limitation?• → Early total care
SUMMARY
LifeLimbPain
FunctionAesthetics
Decreasing priorit
y
‘A fracture is a soft tissue injury which is
complicated by a break in the bony cortex’
Early total care vs.
Damage limitation