Accident - incident that happens unexpectedly and unintentionally
Trauma - Acute physical injury to any part of the body
Polytrauma - simultaneous severe injuries to two or more distinct body regions, where at least one injury is potentially life-threatening and causes critical physiological derangement

Approach to trauma

• Scene safe?
• Patient safe?
• Call for help

xABCDE

• In order of likeliness to outright kill the patient

flowchart TD
	A[Primary survey - xABCDE] --> Resucitation
	Resucitation --> A
	Resucitation --> B[Secondary survey]
	B --> C[AMPLE history]
	B --> D[Head to toe examination]

AMPLE history: Allergies, Medications, Past medical history, Last meal, Events

Fractures

• Pain

• Swelling

• Bruising

• Deformity

• Loss of function

• Tenderness

• Crepitus

• Circulation

• Sensation

• Motor function

Management

• Analgesia

• Immobilisation

• Neurovascular reassessment

• Further imaging

• Orthopaedic referral

• Conservative

• Manage without surgery

• Sling, splint, cast, rehab

• Operative

• Reduction

• External/internal fixation

• Arthroplasty

Open fractures

• Fracture that communicates with outside environment
• IV antibiotics
• Tetanus booster
• Photographs
• Remove cross-contamination
• Cover with saline soaked gauze
• Orthoplastics assessment

Hip fractures

• Older patients
• Leg often appears shortened and externally rotated
• High morbidity and mortality rates
• Intra vs extracapsular - dictates blood supply and management

Long bone fractures

• Major blood loss
• Femur: 1-2L
• Tibia: 0.5-1L
• Humerus: 0.5-0.75L

Knee injuries

• Patella, tibial plateau, distal femur
• Ligamentous injuries
• Dislocation - vascular injury unless proven otherwise

Scaphoid fractures

• Initial x-rays appear normal
• High risk of avascular necrosis

Tibial fractures

• High energy tibial shaft fractures - compartment syndrome

Dislocation

• Complete separation of articulating bony surfaces
• Subluxation - partial/incomplete dislocation where articulating surfaces remain partially in contact
• Orthopaedic emergency when it threatens the skin, blood supply or neurological function

Compartment syndrome

• Limb threatening emergency

flowchart TD
	A[Bleeding/Swelling inside muscle compartment]
	B[Compression of veins]
	C[Reduced venous drainage]
	D[Fluid leaks into tissues]
	E[Increased pressure]
	F[Compression of nerves results in parasthaesia - motor weakness]
	G[Compartment pressure exceeds diastolic BP]
	H[Artrial inflow compromised]
	I[Ischaemia - tissue death]
	J[Permanent nerve and muscle damage]
	A --> B
	A --> E
	B --> C
	C --> D
	D --> E
	E --> B
	E --> G
	E --> F
	F --> J
	G --> H
	H --> I
	I --> J

• Above increased pressure are the methods of causing the increased pressure, either bleeding into compartment directly or fluid entering tissues
• Below increased pressure all paths lead to nerve and muscle damage either by compression of nerves or ischaemia

Assessment

• Pain out of proportion
• Pain with passive stretch of muscles in a compartment
• Parasthesia, pulselessness, paralysis - late signs so likely missed opportunity for treatment

Initial management

• Analgesia (pain relief)
• Remove all dressings - bare skin
• High flow O₂ and IV fluids to improve perfusion
• Reassess within 30 minutes

Investigations

• Not usually required
• Pressure monitors in high risk or unconscious patients

Definitive management

• If no improvement then emergency fasciotomies (cutting the fascia to relieve pressure within a compartment)