musculoskeletal trauma in polytrauma victims
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Musculoskeletal Trauma in Polytrauma Victims. Kris Arnold, MD, MPH. Musculoskeletal Trauma in Multitrauma Patients. 85% of multi trauma patients have musculoskeletal trauma Rare immediate threat to life or extremity viability Indicator of risk for torso injury

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musculoskeletal trauma in multitrauma patients
Musculoskeletal Traumain Multitrauma Patients
  • 85% of multi trauma patients have musculoskeletal trauma
  • Rare immediate threat to life or extremity viability
  • Indicator of risk for torso injury
  • Common cause of prolonged or permanent disability if not treated properly
musculoskeletal injury issues during primary survey
Musculoskeletal Injury Issues During Primary Survey


  • Bleeding from open fractures
  • Bleeding from closed long bone fractures
    • Humerus 1-2 units blood
    • Femur 3-4 units blood
  • Bleeding from pelvic fracture
    • May be exsanguinating
  • Vascular & Neurologic injury from dislocations
pelvic fractures
Pelvic Fractures
  • Pelvis fracture severity based on breaking ring structure

Image Source:

pelvic fractures1
Pelvic Fractures
  • Type A – No instability of ring
    • Avulsion of single bone – low risk
      • Rehabilitation – progressive weight-bearing
      • Late surgical intervention

Image source: Michael E. Stadnick, M.D

pelvic fractures2
Pelvic Fractures
  • Type B
  • Disruption anteriorly and posteriorly with intact posterior ligaments
  • Problems
    • Rotational instability
    • Increased risk of bleeding
    • Associated injuries
      • Urethra
      • Pelvic organs
      • Abdominal organs

Open Book

pelvic fractures3
Pelvic Fractures
  • Type C
  • Anterior and posterior disruption with disruption of posterior sacro-iliac complex
    • Rotational and vertical instability
    • High risk of bleeding
    • High risk associated injuries
      • Urethral
      • Pelvic organs
      • Abdominal organs
emergency pelvic fracture stabilization
Emergency Pelvic Fracture Stabilization

Binding force at level of trochanters

Image source: Michael T. Archdeacon, MD

pelvic fracture management
Pelvic Fracture Management
  • Rule out urethra injury
    • Retrograde urethrogram (RUG)
musculoskeletal injury management during secondary survey
Musculoskeletal Injury Management During Secondary Survey


  • Mechanism of extremity injury
    • Direct blunt force
    • Crush
    • Fall
  • Initial extremity positioning
extremity injury assessment
Extremity Injury Assessment
  • Look
    • Undress completely
    • Deformity
    • Swelling
  • Listen
    • Pain
    • Crepitance
  • Feel
    • Crepitance
    • Abnormal mobility
initial fracture management
Initial Fracture Management
  • Angulated – realign & stabilize
    • Prevent further soft tissue injury
    • Reduce pain
    • Potentially decrease bleeding

Photo source: Bush LA, Chew FS. Subtrochanteric femoral insufficiency fracture in woman on bisphosphonate therapy for glucocorticoid-induced osteoporosis. Radiology Case Reports. [Online] 2009;4:261.

angulated fracture management during prehospital management
Angulated Fracture Management during Prehospital Management

Extremity Vascular Injury Evaluation

Evaluate Distal Perfusion







Reevaluate Distal Perfusion

extremity fracture assessment
Extremity Fracture Assessment
  • Imaging
    • Plain x-rays
    • Two views
      • Anterior-posterior
      • Lateral
        • Must be correctly aligned
    • Image one joint above and below
      • Maissoneuve
open fractures
Open Fractures
  • Realign and splint as for closed
crush injury
Crush Injury
  • Compartment syndrome
  • Rhabdomyolysis
compartment syndrome
Compartment Syndrome
  • Lower Extermity
    • Lower leg
    • Thigh
    • Gluteal
    • Foot
  • Upper Extremity
    • Forearm
    • Hand
compartment syndrome clinical evaluation
Compartment Syndrome Clinical Evaluation
  • Pain out of proportion to injury or worsening
  • Pain with stretching involved muscles
  • Pain with using involved muscles
  • Possible decrease in sensation or paresthesias over or distal to involved compartment
  • Late or inconsistent
    • Loss of peripheral pulse
    • Loss of normal color – pale
    • Paralysis of involved muscles
  • Tissue pressure >35-40cm H2O w/ normal systemic BP –lower w/ hypotension (normal <10cm H2O)


Fractures and Crush Injurues

Electrocution/ Thermal Burns

Burned Muscle

“Tea colored” urine

Heme + urinalysis dip

No red blood cells on microscopic