title: Particularities of hand and wrist complex injuries in polytrauma management.
abstract: Hand and wrist lesions are relatively common in polytraumatised patients. These subjects sustain a wide range of potential life-threatening conditions and hand and wrist injuries incurred are often not diagnosed or are insufficiently treated. Closed lesions are the most frequently missed diagnosis, but even severe open lesions may be incorrectly treated. Most of these hand and wrist injuries can have a strong negative impact on long-term quality of life, particularly when treatment of these injuries is poor or delayed. Orthopaedic and hand surgeons should be vigilant in their assessment and treatment of patients with multiple injuries and a global approach, based on the advanced trauma life support (ATLS)-protocol, must be applied. The very common association of head, chest, abdomen, bone and soft-tissue lesions in the polytraumatised patient requires a multidisciplinary team approach from the beginning. The energy of trauma in these patients often causes complex injuries to the wrist and hand; these require correct treatment in terms of both timing and techniques. It is not possible to create a practical, useful guideline with a "one lesion-one solution" approach, because every case is different; therefore, this paper describes a spectrum of indications and techniques that may be useful in managing hand and wrist injuries, particularly in polytraumatised patients.
authors.affiliation: U.O.C Muscoloskeletal Traumatology, U.O.D. Microsurgery, C.T.O. Hospital, Torino, Italy. Electronic address: davide.ciclamini@gmail.com.
authors.forename: Davide
authors.initials: D
authors.lastname: Ciclamini
authors.affiliation: U.O.C Muscoloskeletal Traumatology, U.O.D. Microsurgery, C.T.O. Hospital, Torino, Italy.
authors.forename: Bernardino
authors.initials: B
authors.lastname: Panero
authors.affiliation: U.O.C Muscoloskeletal Traumatology, U.O.D. Microsurgery, C.T.O. Hospital, Torino, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Titolo
authors.affiliation: U.O.C Muscoloskeletal Traumatology, U.O.D. Microsurgery, C.T.O. Hospital, Torino, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Tos
authors.affiliation: U.O.C Muscoloskeletal Traumatology, U.O.D. Microsurgery, C.T.O. Hospital, Torino, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Battiston
mesh_terms: D050824:Carpal Joints / Q000000981:diagnostic imaging; D003161:Compartment Syndromes / Q000000981:diagnostic imaging / Q000601:surgery*; D042241:Early Diagnosis; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006230:Hand Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008023:Ligaments, Articular / Q000293:injuries / Q000601:surgery; D008297:Male; D009104:Multiple Trauma / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D016059:Range of Motion, Articular; D057772:Vascular System Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D014954:Wrist Injuries / Q000000981:diagnostic imaging / Q000601:surgery*
keywords: Complex injuries; Hand injuries; Polytrauma; Wrist injuries