Acute Extremity Trauma
Acute extremity trauma can require a team of specialists in order to fully manage the potential problems. For the most serious extremity trauma, orthopedic surgeons, plastic surgeons, vascular surgeons, infectious disease as well as rehabilitation specialists work together to provide a patient with the best opportunity to save their limb. When the injury is so severe that amputation is recommended, these specialists work together to determine amputation level to help the patient achieve the most optimal functional outcome.
Broken bones (fractures) as the result of extremity trauma can be simple uncomplicated fractures, or open (the bone has penetrated the skin), comminuted (the bone is in multiple pieces), and displaced (the bone fragments aren’t in alignment). Ligaments can be torn or severely strained. Cartilage might be damaged due to fracture through the joint. For a patient with any of these injuries, an orthopedic surgeon will evaluate and manage these problems.
Traumatic injuries like motorcycle accidents often result in significant soft tissue damage. A plastic surgeon may be needed to assess the extent of injury and make recommendations for soft tissue reconstruction. In accidents that result in hand and finger partial or complete amputation, a plastic surgeon with specialty training in hand surgery is instrumental in repairing these injuries.
If there is significant injury to any major blood vessel in the extremity, a vascular surgeon will be consulted in order to repair the damaged vessel. Unrecognized vascular injury can lead to amputation or even death if not managed rapidly.
When an extremity trauma results in an open wound, infectious disease specialists are consulted. An open wound has the potential to become infected so these specialists assess the type of wound, and any potential infecting organisms. They then make recommendations regarding antibiotics to use in order to minimize the chance of infection.
Compartment syndrome is a potential problem in extremity trauma and if not recognized can lead to amputation. The muscles of our arms and legs are separated into “compartments” and a thick layer of fascia is the “wall” of the compartment. If there is a vascular injury that results in bleeding into the compartment, pressure will build up in the compartment. This increase in pressure can cause the muscles to die and if not recognized can require amputation. Emergency physicians or the consulting surgeons are trained to recognize signs of this problem. If a compartment syndrome is suspected, a fasciotomy (cutting through the fascial “wall”) is done in order to release the pressure in the compartment.
Rehabilitation specialists (physical medicine and rehabilitation physicians) are part of the post-surgical team and help address any rehabilitation issues following traumatic extremity injury. They work closely with physical and occupational therapists to help the patient regain function following difficult injuries.
While this is certainly not a comprehensive list of the potential issues of extremity trauma, it includes some of the more common problems that do occur. A team of specialists helps to assure the best possible outcome following extremity injury.