Page 146 - ASOP ROT Study Guide

TRAUMA

1. INTRODUCTION

Trauma is an injury to the body, usually resulting from an external force. Trauma results in
damage to body tissues in muscles, blood vessels, nerves, ligaments and bones. In this module
we will concentrate on skeletal trauma. Skeletal trauma is injury of the skeletal system, usually
resulting in broken bones (fractures).

Broken bones are a common phenomenon. Most people have either broken one of their own bones
or know someone who has broken a bone.

Some of us think of bones as dead, inert things but in reality they are very much alive. They have
a very rich blood supply and the periosteum (the membrane which covers the outside of bones)
has a nerve supply. Therefore the immediate consequences of breaking a bone (fracture) are
severe pain and blood loss. The early management of a fracture must concentrate on minimizing
the effects of blood loss and reducing the pain.

In the longer term the rich blood supply to the bone must be re-established before the bone will
heal. From the outset, therefore, the condition of the soft tissues containing the blood vessels will
be considered by the surgeon when choosing the most appropriate treatment.

Finally it must be remembered that, although fractures are serious injuries, other injuries received
in the same incident (head, chest and abdominal injuries) may be more serious. So, although
fractures may be obvious, they are not the surgeon's first consideration when treating an injured
person.

2. HISTORY TAKING AFTER TRAUMA

After trauma, a careful history (information about the person and the circumstances before, during
and after the injury) must be taken. There are two principal reasons for this: clinical and medico-
legal.

2.1 Clinical Aspects

Bones may be fractured (broken) in many ways, from simple accidents in the home (which are the
most common) to high velocity transport accidents or, more rarely, in battle. See Figure 1A (a
crashing injury), Figure IB (a direct fall causing a fracture), and 1C (a fracture caused by a
twisting or indirect force).

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