Introduction

INTRODUCTION

In several chapters the importance of life-threatening trauma is emphasised, but numerically for every patient who dies follow ing a traumatic event there are three who are left with a lifelong functional impairment. Extremity trauma can be thought of as injury in isolation or in the context of trauma to the whole body . In the latter scenario extremity trauma and the mode in which it is managed may be important, as is the physiological stability of the patient – a concept known as damage control orthopaedic surgery . Furthermore, extremity trauma not only involves the bones, most obviously through a fracture, but also involves the surrounding soft-tissue envelope and thus could describe injury to nerves, other connective tissue and skin. The goal of extremity trauma management is to return the injured area to optimal function as quickly as possible and therefore return function to the patient. The management of extremity trauma is step-wise and involves initially sa ving the patient’s life by the identification and treatment of life- and limb-threatening injuries, according to the Advanced Trauma Life Support (ATLS) principles. ATLS principles are a use ful starting point in the evaluation of extremity trauma. They put the injury into context, attributing to it a priority in the management of all the patient’s injuries; for example, a trau matic head injury may require management bef ore operative femoral fracture stabilisation with an intramedullary nail, yet the application of traction to the a ff ected limb, or an exter nal fixator, may reduce the physiological insult to the patient as a whole. T herefore, the context of extremity trauma is extremely important. Applying the principles of ATLS in the initial assessment, f ollowed by damage control orthopaedics in the ongoing surgical management, provides a framework for patient management. One could summarise this by noting that treatment depends on patient factors, injury-specific factors and surgeon factors, including the resources available. It is imperative f or the clinician to involve the patient in the decision-making process when it comes to the choice of treatment for that individual. Moreover, treatment priorities, functional demands and risk versus benefit vary from individ - ual to individual. -

The range of available treatments • How to select an appropriate treatment •