Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-27T23:02:46.187Z Has data issue: false hasContentIssue false
  • English
  • Français

Prehospital Care of Orthopedic Injuries

Published online by Cambridge University Press:  28 June 2012

Eitan Melamed ,
Amir Blumenfeld ,
Boaz Kalmovich ,
Yona Kosashvili ,
Guy Lin ,
Amir Korngreen ,
Igal Mirowsky ,
Rami Mosheiff ,
Dror Robinson  and
Moshe Salai
Eitan Melamed*
Affiliation:
Israel Defense Forces (IDF) Trauma Branch, Surgeon General Headquarters, IDF Medical Corps
Amir Blumenfeld
Affiliation:
Israel Defense Forces (IDF) Trauma Branch, Surgeon General Headquarters, IDF Medical Corps
Boaz Kalmovich
Affiliation:
Israel Defense Forces (IDF) Trauma Branch, Surgeon General Headquarters, IDF Medical Corps
Yona Kosashvili
Affiliation:
Israel Defense Forces (IDF) Trauma Branch, Surgeon General Headquarters, IDF Medical Corps
Guy Lin
Affiliation:
Israel Defense Forces (IDF) Trauma Branch, Surgeon General Headquarters, IDF Medical Corps
Amir Korngreen
Affiliation:
Trauma Service, Department of Orthopedic Surgery, Soroka University Medical Center, Beer-Sheba, Israel
Igal Mirowsky
Affiliation:
Chief of Spine Surgery, Department of Orthopedic Surgery, Assaf-Harofe Medical Center, Zrifin, Israel, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
Rami Mosheiff
Affiliation:
Trauma Service, Department of Orthopedic Surgery, Hadassah Medical Center, Jerusalem, Israel, Hebrew University School of Medicine, The Hebrew University, Jerusalem, Israel
Dror Robinson
Affiliation:
Department of Orthopedic Surgery, Rabin Medical Center-Golda Campus, Petahtiqua, Israel, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
Moshe Salai
Affiliation:
Department of Orthopedic Surgery, Rabin Medical Center-Beilinson Campus, Petahtiqua, Israel, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
*
IDF Trauma Branch PO Box 02149 Israel E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Orthopedic injuries are predominant among combat casualties, and carry the potential for significant morbidity. An expert consensus process (Prehospital care of military orthopedic trauma: A consensus meeting, Israel Defense Forces Medical Corps, May 2003) was used to create guidelines for the treatment of these injuries by military prehospital providers. The consensus treatment guidelines developed by experienced orthopedic trauma personnel from leading trauma centers in Israel are presented in this paper.

For victims with open fractures, the first priority is hemorrhage control. Splinting, irrigation, and wound care should be performed while waiting for transport, or, in any scenario, in the case of an isolated limb injury. The use of traction splints was advocated for both the rapid transport scenario (up to one hour from the time of injury to arrival at the hospital) and the delayed transport scenario. In the urban setting, traction splints may not be necessary. Any victim experiencing pelvic pain following a high-energy mechanism of injury should be presumed to have an unstable pelvic fracture, and a sheet should be tied around the pelvis. The panel agreed that field-reduction of dislocations should be avoided by the medical officer unless it is anticipated that the patient will need to go through a long evacuation chain and the medical officer is familiar with specific reduction techniques.

Keywords

bone injurycircumferential sheetdislocationsfracturesorthopedic injuriespelvic injuriesprehospital caresplinting
Type
Special Report
Information
Prehospital and Disaster Medicine , Volume 22 , Issue 1 , February 2007 , pp. 22 - 25
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Bellamy, R: Combat Trauma Overview. In: Zajtchuk, R, Grande, C, (eds), Anesthesia and Perioperative Care of the Combat Casualty. Textbooks of Military Medicine. Falls Church, VA: Office of the Surgeon General, United States Army, 1995, pp 1–42.Google Scholar
2.Mabry, R, Holcomb, J, Baker, AM,et al: United States Army Rangers in Somalia: An analysis of combat casualties on an urban battlefield.J Trauma 2000;49(3):515–528; discussion 528–529.CrossRefGoogle Scholar
3.Jacob, E, Erpelding, J: A retrospective analysis of open fractures sustained by US military personnel during Operation Just Cause.Mil Med 1992;157(10):552–556.CrossRefGoogle ScholarPubMed
4.Tscherne, H, Gotzen, L:Fractures with Soft Tissue Injuries. Berlin: Springer-Verlag, 1984.CrossRefGoogle Scholar
5.Patzakis, M, Wilkins, J: Factors influencing infection rate in open fracture wounds.Clin Orthop 1989;243:36–40.CrossRefGoogle Scholar
6.Gustilo, R, Anderson, J: Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: Retrospective and prospective analysis.J Bone Joint Surg 1976;58(4):453–458.CrossRefGoogle Scholar
7.Czymek, R, Lenz, S, Dusel, W: [Prevention of infection in war wounds]. Chirurg 1999;70(10):1156–1162.CrossRefGoogle Scholar
8.Frame, S: Prehospital Care. In: Mattox, K, Feliciano, D, Moore, E, (eds), Trauma, 4th ed. New York: McGraw-Hill Book Co., 2000, pp 103–126.Google Scholar
9.Gray, HMW: The Early Treatment of War Wounds. London: H Frowde and Hodder and Stoughton, 1919.Google Scholar
10.Kirkup, J: Fracture care of friend and foe during World War I. Anz J Surg 2003;73(6):453–459.CrossRefGoogle ScholarPubMed
11.Rowlands, T, Clasper, J: The Thomas splint–A necessary tool in the management of battlefield injuries.J R Army Med Corps 2003;149(4):291–293.CrossRefGoogle ScholarPubMed
12.Battlefield Advanced Trauma Life Support (BATLS): Chapters 10 & 11.J R Army Med Corps 2003;149:58–63.CrossRefGoogle Scholar
13.Wolinsky, P, Johnson, K: Femoral Shaft Fractures. In: Browner, B, Jupiter, JB, Levine, AN, Trafton, PG, (eds), Skeletal Trauma, 2d ed. Philadelphia: WB Saunders Co., 1998, pp 1927–2032.Google Scholar
14.Abarbanell, NR: Prehospital midthigh trauma and traction splint use: Recommendations for treatment protocols. Am J Emerg Med 2001;19(2):137–140.CrossRefGoogle ScholarPubMed
15.Wood, S, Vrahas, M, Wedel, S: Femur fracture immobilization with traction splints in multisystem trauma patients.Prehosp Emerg Care 2003;7(2):241–243.CrossRefGoogle ScholarPubMed
16.Koval, K, Zuckerman, J: Handbook of Fractures, 2d ed.Philadelphia: Lippincott Williams & Wilkins, 2002, pp 196–203.Google Scholar
17.Chip Routt, M, Falicov, A, Woodhouse, E, Schildhauer, T: Circumferential Pelvic Antishock Sheeting: A temporary resuscitation aid.J Orthop Trauma 2002;16(1):45–48.CrossRefGoogle Scholar
18.Simpson, T, Krieg, J, Heuer, F, Bottlang, M: Stabilization of pelvic ring disruptions with a circumferential sheet.J Trauma 2002;52(1):158–161.Google ScholarPubMed
19.American College of Surgeons:Advanced Trauma Life Support for Doctors, ATLS, Instructor Course Manual. Chicago: American College of Surgeons; 1997, pp 206–209.Google Scholar
20. Committee of the National Association of Emergency Medical Technicians in Cooperation with the Committee on Trauma of the American College of Surgeons. Musculoskeletal Trauma. In: Prehospital Trauma Life Support, 5th ed.St. Louis: Mosby, 2003, pp 285–286.Google Scholar