TRAUMA

Management of acute trauma is an accurate science governed by specific protocols. The trauma team, headed by the orthopaedic surgeon, comprises of the general surgeon, the neurosurgeon and the anaesthesiologist and various other specialties as required. It also involves the services of trained paramedic personnel and staff nurses.

The trauma team swings into action as soon as the patient is rolled into the ER. Following a primary survey, basic resuscitation measures are instituted to derive the maximum benefit for the patient in the ‘golden hour’ following any trauma. This is followed by a secondary survey to identify any injuries overlooked in the initial assessment. Ultra sonogram, CT scan and MRI aid in the diagnosis but nothing can substitute a well- trained, qualified, alert and dedicated trauma surgeon.

Orthopaedic trauma management has come a long way since the days of plaster- of- paris casts and traction. Many methods of fixation of fractures are now available viz. external fixation, fixation with plate and screws, locking intramedullary nail fixation.

Orthopaedic implants are made from non- corrosive, non- reactive metals such as stainless steel and titanium. In recent years bio- absorbable plates and screws have been devised which gradually dissolve inside the body and do not require removal.

As the hazards of prolonged immobilization of the body, as a whole, and of the joints, especially, are being realized, more and more fractures are being treated with operative rigid fixation. This allows early mobilization of the patient and prevents the complications associated with prolonged immobilization such as hypostatic pneumonia, deep vein thrombosis, pulmonary embolism, joint stiffness, muscle wasting, fracture disease etc.

Also early mobilization improves the physiological circulation in the injured limb and aids in fracture healing.

Our institution is a major trauma centre. We perform about 500 plate and screw fixations, 300 tibial nailings, 300 femoral nailings, 500 external fixator applications, 200 hemiarthroplasties of the hip joint and about 500 other assorted fracture fixation surgeries in a year. Our results have been especially heartening and our infection rate practically nil, even in grade IIIb open fractures.

That is not to say that the conservative line of management using plaster- of- paris casts or traction has been done away with entirely. We perform about 500 closed reductions and plaster cast applications in a year and occasionally treat patients in traction.