Case Management: Orthopedic Care of the Polytrauma Patient

Tibial shaft fractures are the most common long-bone fracture, with an incidence of 492,000 per year, according to data from the U.S. National Center for Health Statistics. As many as one-quarter of these injuries are open fractures that typically occur in young people and are associated with high velocity impact, such as motor vehicle collisions and sports-related trauma. The Gustilo-Anderson grading system is used to classify open fractures on the basis of (1) size of the open wound, (2) degree of contamination, (3) extent of associated soft tissue injury, and (4) neurovascular status. The higher the grade, the greater the risk for infection, need for bone grafting, and likelihood of amputation.

The Gustilo-Anderson grading system, damage control orthopedic practices and intramedullary nailing have provided innovative improvements in orthopedic care. Click here to read Dr. Walter Virkus—Director, Orthopedic Trauma Services at Indiana University Health and IU Health Physicians, and professor of orthopedic surgery at Indiana University School of Medicine—describe initial assessments and management of polytrauma patients, the “second hit” phenomenon and damage control orthopedics. As well as the benefits of reamed versus non-reamed intramedullary nailing and complications associated with severe lower extremity fractures.

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Case Management: Orthopedic Care of the Polytrauma Patient

Tibial shaft fractures are the most common long-bone fracture, with an incidence of 492,000 per year, according to data from the U.S. National Center for Health Statistics. As many as one-quarter of these injuries are open fractures that typically occur in young people and are associated with high velocity impact, such as motor vehicle collisions and sports-related trauma. The Gustilo-Anderson grading system is used to classify open fractures on the basis of (1) size of the open wound, (2) degree of contamination, (3) extent of associated soft tissue injury, and (4) neurovascular status. The higher the grade, the greater the risk for infection, need for bone grafting, and likelihood of amputation.

The Gustilo-Anderson grading system, damage control orthopedic practices and intramedullary nailing have provided innovative improvements in orthopedic care. Click here to read Dr. Walter Virkus—Director, Orthopedic Trauma Services at Indiana University Health and IU Health Physicians, and professor of orthopedic surgery at Indiana University School of Medicine—describe initial assessments and management of polytrauma patients, the “second hit” phenomenon and damage control orthopedics. As well as the benefits of reamed versus non-reamed intramedullary nailing and complications associated with severe lower extremity fractures.

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