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ACCIDENT & TRAUMA SURGERY


Trauma can be defined as physical injuries caused by accidents and impacts. Trauma patients can be the victims of injuries ranging from a simple fall at home to complex injuries following road accidents. Trauma surgery is the stream which involves in surgical treatments for physical injuries, especially emergency situations such as accident cases. A team approach involving Doctors from various specialties and para medical staffs is necessary in addressing and resuscitating these patients.


Trauma patients usually present with multiple injuries which may involve the brain, face, chest, abdomen, pelvis, bone, blood vessels, nerves and soft tissues. Immediate primary care and resuscitation is the key in saving these patients which is possible only in tertiary centers with round the clock emergency care.


Once the patient is stabilized, the fractures and other injuries are addressed. The common orthopaedic procedures performed are


Nailing

Compression Plating

Locking plate fixation

Minimally invasive fixation (Small incision)

External fixation

Illizarov fixation (Ring fixation)


Nailing:

It is a procedure where the fractures of the long bones in the body are fixed with a long nail and screws. The fractures of the arms, thighs and legs are usually fixed with a nail. As it is load sharing, patients can start walking with support on the very next day of surgery.


Compression Plating:

The smaller bones in the body like the forearm and hand are usually fixed with compression plates and screws. They help to align the fractures perfectly are allowed early mobilization of the affected part.


Locking plate fixation:

It is a recent advancement in Orthopaedic implant design to address fractures of the weak bones. These plates provide an extra rigid fixation and hence prevent implant failure in elderly osteoporotic patients.


Minimally invasive fixation (MIPPO technique):

Another advancement in surgical techniques are the minimally invasive surgeries which are more cosmetic in nature because of the use of smaller incisions and less tissue damage. They help in early wound healing and faster recovery.


External fixation:

Fractures with wounds are prone for infection. In such instances where a routine plate or nail fixation cannot be done, external fixators are used to temporarily fix these fractures till the soft tissues heal. They are not permanent but a temporary mode of fracture treatment.


Illizarov fixation:

This is another method of external fixation in infected or grossly comminuted fractures where routine surgeries cannot be performed. They are also indicated in deformity correction or limb lengthening procedures.


First Aid Care:

The immediate care of a trauma victim plays a vital role in saving them. Following an accident, emergency services must be informed immediately. The basic supports that can be given are


If you have been injured in the accident, first check yourself for any injuries. Try to assess how well you can move your limbs, and if you experience symptoms such as dizziness etc. You need to be fit enough to help the others.

If other people are injured, first assess the extent of his/ her injuries. For e.g. blood from the head, neck, arms legs, abdomen back etc. Treat the quietest person first, they are usually more seriously injured or cannot breathe. People who can talk or scream, on the other hand, can breathe therefore can be treated a little later. Ask for the patient’s name, if he responds, it means he is able to understand the situation and has most likely not suffered a severe head injury.


Next, check if the person is breathing and if he has a pulse.

Immediately call for an ambulance or rush the person to a hospital. Once you know more about the patient’s condition you will in a better position to tell the doctors about his/her condition.

If you do not hear any breath sounds, check his/her mouth for any obstructions. If there is something obstructing the airway, use your index and middle finger to clear the airway.

If there is no pulse, start CPR or EAR.


Keep the person’s neck straight to start EAR (External Air Resuscitation) or CPR (Cardio pulmonary resuscitation).

There are 3 types of EAR; Mouth-to-mouth, Mouth-to-Nose, Mouth-to-Mask.

8. If there is bleeding from the mouth or the patient is vomiting, turn the person to his/her side. This will avoid any chances of the person choking. Place the person’s arm that is under him straight out and the arm closest to you across his chest.

If there are extensive wounds, try to control the bleeding using pressure to the area using a cloth. Press down with your palms rather than your finger tips.

Always suspect spinal injuries. If the person’s neck is in an awkward position (not normally placed) or the person is unconscious, do not move the patient. Get help immediately. This could mean that the person’s neck is broken, and moving him/her in such a situation can cause more harm than good.

If you do not hear any breath sounds, check his/her mouth for any obstructions. If there is something obstructing the airway, use your index and middle finger to clear the airway.

Keep the person warm. Usually accident victims feel excessively cold due to shock. Therefore keeping them warm is essential to survival.

Do not give water or anything through the mouth, it could lead to the patient choking.

While shifting a patient to the hospital, here are a few things you should keep in mind:

The patient should be transported on a stretcher or stiff board.

Keep the person’s neck and back straight. You could place a rolled up towel or thick cloth under the neck for better support.

Ensure that the person is lying down flat.

If there is only a limb injury, the patient can be transferred in a sitting position.

In case of a bleeding injury, lift the injured part above the body level and apply pressure

Make sure the person has a pulse and is breathing on the way to the hospital. If he/she stops breathing, be prepared to start CPR or EAR in the vehicle.


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    Contact

    TOSH(Trauma & Orthopaedic Speciality Hospital)
    #72, Ormes Road,
    Kilpauk, Chennai
    India
    Pin: 600010.
    Email: toshenquiry@gmail.com

    For Appointments:

    +91-44 4903 4903
    +91 9894467903
    Email: toshenquiry@gmail.com