title: Treatment of the multiply injured patient: plans for treatment and problems of major trauma.
abstract: Certain principles involved in the treatment of fractures have stood the test of time. The thrust of modern orthopaedics has been to decrease morbidity by combining these principles with developments in physiology, bioengineering, radiology, and antibiotics. The goal remains anatomic bone union without infection and normal joint and muscle function. The surgeon's mission is to achieve this goal. For the multiply injured patient, survival depends on the quality of care. Surgical orientation permits one to stabilize the fractures and restore the patient to activities of daily living. Multiple fractures set the stage for multiple organ failure, and, as we have discussed, stabilization reduces the incidence of these problems. Basically, open fractures must be stabilized with plaster, traction, or surgery. Multiple fractures need rigid stabilization, which can be achieved with various techniques without jeopardizing limb or life. A simple, comprehensive plan should be implemented when the patient arrives in the emergency room. Treatment requires an interdisciplinary approach, with the surgeon heading a team of physicians, nurses, and technicians capable of handling the complications of each organ system. Teamwork and dedication to excellence by all involved will decrease mortality and morbidity. Survival is to be anticipated. If we have restored the anatomy early, before any organ failure, we are then ready to begin rehabilitation and achieve a much finer and enduring end result for the injured patient.
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003161:Compartment Syndromes / Q000601:surgery; D050723:Fractures, Bone / Q000145:classification / Q000601:surgery; D006801:Humans; D007674:Kidney Diseases / Q000628:therapy; D009212:Myoglobinuria / Q000628:therapy; D009747:Nutritional Physiological Phenomena; D010437:Peptic Ulcer / Q000628:therapy; D011655:Pulmonary Embolism / Q000628:therapy; D012128:Respiratory Distress Syndrome / Q000628:therapy; D012151:Resuscitation; D012769:Shock / Q000628:therapy; D013312:Stress, Physiological / Q000150:complications; D014947:Wounds and Injuries / Q000628:therapy*
chemical_list: D000900:Anti-Bacterial Agents