Table Of ContentMatthew P. Lungren
Michael R.B. Evans
Textbook
Editors
of Polytrauma
Clinical Medicine
CMoavneratgeemmpleantet
SAu Mbtuitltleid fioscr iplinary Approach
Clinical Medicine Covers T3_HB
Hans-Christoph Pape
SJoecsoenpdh EBdoirtiroenlli Jr.
Ernest E. Moore
Roman Pfeifer
Philip F. Stahel
Editors
Third Edition
112323
Textbook of Polytrauma Management
Hans-Christoph Pape
Joseph Borrelli Jr.
Ernest E. Moore
Roman Pfeifer • Philip F. Stahel
Editors
Textbook of Polytrauma
Management
A Multidisciplinary Approach
Third Edition
Editors
Hans-Christoph Pape Joseph Borrelli Jr.
Department of Trauma Surgery Department of Orthopaedic Surgery
University Hospital Zürich & Sports Medicine
Zürich, Switzerland The University of South Florida
Morsani College of Medicine
Ernest E. Moore Tampa, FL, USA
Ernest E. Moore Shock Trauma Center at
Denver Health Roman Pfeifer
University of Colorado Klinik für Traumatologie
Denver, CO, USA University Hospital of Zürich
Zürich, Switzerland
Philip F. Stahel
Rocky Vista University
College of Osteopathic Medicine
Parker, CO, USA
ISBN 978-3-030-95905-0 ISBN 978-3-030-95906-7 (eBook)
https://doi.org/10.1007/978-3-030-95906-7
© Springer Nature Switzerland AG 2011, 2016, 2022
Previous editions published with Springer-Verlag Berlin Heidelberg
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Foreword
In this comprehensive textbook, experts in the field of various systems pathol-
ogy, inflammatory and immune response, pediatrics, and gerontology address
the issues that may affect the clinical course in patients with severe multiple
injuries.
Most standard textbooks that deal with simple or complex fractures have
focused on anatomy, pathology, and occasionally complications of the mus-
culoskeletal injury. Likewise, those that focus on the aspects of general sur-
gery demonstrated a certain lack of management principles for fracture care.
This textbook overcomes this particular issue and emphasizes on clinical
decision-making.
This is important, as certain situations, such as extremes of age, extremes
of soft-tissue or osseous injury, and other special situations, such as preg-
nancy, represent the true challenge for a good outcome.
These “associated” elements of the clinical decision-making process are
the most difficult to teach and the most dependent on the clinical experience
and have rarely been centralized and addressed in a single course. It has
become evident that along with the centralization of trauma care in Western
societies and the associated certification processes, the technical aspects to
address acute hemorrhage and fracture fixation strategies are not necessarily
the primary issue in most clinical scenarios.
As trauma training of a musculoskeletal surgeon evolves, he/she may be
the most senior physician on the trauma team, and the need for a reference to
validate the opinions of those comanaging the patient may evolve acutely in
the absence of a full team of expertise.
This compilation of special situations and discussion in this single source
will serve as a reference for the traumatologist, whether the basis of his/her
training is general or orthopedic surgery and whether the practice is entirely
trauma or they give part of their time outside of their clinical interest to cover
the call burden of an active trauma hospital.
The sections on epidemiology, costs, and outcomes of these injuries to the
lives of our patients and the society that shares the costs of those injuries are
humbling to those of us who provide care and remind us that a good outcome
is more than a good X-ray.
University of Texas Andrew R. Burgess
Houston, TX, USA
v
Preface
This book focuses on the multidisciplinary management of a patient with
multiple injuries. The third edition of this book has been modified with a
continued emphasis on the concept of including all subspecialties involved in
trauma care.
Certain changes in trauma care—such as improved resuscitation, manage-
ment of coagulopathy, selective role of damage control, knowledge about the
risks for complications, and new scoring systems—have been added. Also,
the part on trauma system changes and their influence on rescue conditions
has been updated. The selection of authors continues to be twofold. All of
them are experts in their particular fields. In addition, we have sought to
include contributions from all over the world, thus respecting the fact that
trauma is a global challenge.
This textbook has also been expanded in terms of outcome assessment for
certain injury types known to be responsible for long-term issues. Among
these are bone infections, bone defects, and certain fracture types.
We hope that these changes will improve trauma care and challenge all to
continue research to optimize outcome.
Zürich, Switzerland Hans-Christoph Pape
Tampa, FL, USA Joseph Borrelli Jr.
Denver, CO, USA Ernest E. Moore
Zürich, Switzerland Roman Pfeifer
Parker, CO, USA Philip F. Stahel
vii
Contents
Part I General Aspects of Trauma Care
1 Impact of Trauma on Society . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Hans-Peter Simmen, Carina Eva Maria Pothmann,
Hans-Christoph Pape, and Valentin Neuhaus
2 Economic Aspects of Trauma Care . . . . . . . . . . . . . . . . . . . . . . . . 11
Yousif Atwan and Emil H. Schemitsch
3 Evidence-Based Trauma Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Daniel Axelrod, Marianne Comeau-Gauthier,
Taylor Woolnaugh, Herman Johal, and Mohit Bhandari
Part II Acute Period (1–3 h)/Prehospital Phase and Trauma Bay
4 Trauma System and Rescue Strategies . . . . . . . . . . . . . . . . . . . . . 29
Beat Schnüriger and Wolf E. Hautz
5 Preclinical Management/Rescue . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Achatz Gerhard, Hossfeld Björn, and Friemert Benedikt
6 Initial Assessment and Diagnostics . . . . . . . . . . . . . . . . . . . . . . . . 59
Philip F. Stahel and Adrian W. Olson
7 Volume and Blood Management . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Alexander Kaserer, Julian Rössler, and Donat R. Spahn
8 Resuscitative Endovascular Balloon Occlusion
of the Aorta . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Charles J. Fox and Ernest E. Moore
9 Preperitoneal Pelvic Packing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Julia R. Coleman, Ernest E. Moore, and Clay Cothren Burlew
Part III P rimary Period (First 72 h)/Clinical Phase
10 Pathophysiology: Trauma-Induced Coagulopathy . . . . . . . . . . . 103
Navin Ganesh Vigneshwar, Hunter B. Moore,
and Ernest E. Moore
ix
x Contents
11 The Inflammatory and Barrier Response After Polytrauma . . . 113
Ebru Karasu and Markus Huber-Lang
12 Pathophysiology: Remote Organ Injury . . . . . . . . . . . . . . . . . . . . 127
Martijn van Griensven
13 Polytrauma Scoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Sascha Halvachizadeh and Hans-Christoph Pape
14 Head Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
Philip F. Stahel and Colin Buchanan
15 Chest Trauma: Classification and Influence
on the General Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Ümit Mert, Hagen Andruszkow, and Frank Hildebrand
16 Blunt Abdominal Trauma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
Alain Corcos and Andrew B. Peitzman
17 Penetrating Injuries of the Thorax . . . . . . . . . . . . . . . . . . . . . . . . 205
Areg Grigorian and Kenji Inaba
18 Penetrating Abdominal Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . 217
Ning Lu and Walter L. Biffl
19 Pelvic Ring Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
Philip F. Stahel and Darryl A. Auston
20 Spine Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
Philip F. Stahel and Sebastian Weckbach
21 Spinal Cord Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253
Philip F. Stahel, Grégoire P. Chatain, and Michael A. Finn
22 Urological Injuries in Polytraumatized Patients . . . . . . . . . . . . . 267
Patricia John, David Pfister, and Axel Heidenreich
23 Gyn. Injuries/Pregnant Patient in Polytrauma . . . . . . . . . . . . . . 281
Axel Gänsslen and Annelie Weinberg
24 Vascular Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
L. P. H. Leenen
25 Compartment Syndrome: Pathophysiology, Diagnosis,
and Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317
Joseph Borrelli Jr. and David Donohue
26 Damage Control in Abdomen and Thorax . . . . . . . . . . . . . . . . . . 339
Andrew Nguyen and Raul Coimbra
27 Fracture Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 359
Roman Pfeifer and Hans-Christoph Pape
28 Mangled Extremity: Management in Isolated
Extremity Injuries and in Polytrauma . . . . . . . . . . . . . . . . . . . . . 377
Peter Kloen, Mark L. Prasarn, Craig Klinger,
and David L. Helfet
Contents xi
29 Surgical Management: Elderly Patient with Polytrauma . . . . . . 395
Conor N. O’Neill and Stephen L. Kates
30 Pediatric Polytrauma Management . . . . . . . . . . . . . . . . . . . . . . . 419
Thomas Lustenberger and Ingo Marzi
31 Surgical Management: Management of Traumatic
Bone Defects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 431
Nikolaos Patsiogiannis and Peter V. Giannoudis
32 Surgical Management: Acute Soft Tissue
and Bone Infections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 445
Lena M. Napolitano
Part IV S econdary Period (3–8 Days)
33 ICU Management: Disseminated Intravascular
Coagulation (DIC) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 473
Satoshi Gando and Takeshi Wada
34 Early ICU Management of Polytrauma Patients
Who Develop Sepsis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 503
Frederick A. Moore
35 Polytrauma and Multiple Organ Dysfunction . . . . . . . . . . . . . . . 519
Barclay T. Stewart and Ronald V. Maier
36 ICU Management: General Management
in the Elderly in ICU. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 541
Basil Andreas Hatz, Franziska Ziegenhain,
and Kai Oliver Jensen
37 ICU Management: Clearing Patients for Surgery . . . . . . . . . . . . 547
Max Lempert and Hans-Christoph Pape
38 ICU Management: Venous Thromboembolism . . . . . . . . . . . . . . 553
Takahiro Niikura
Part V Tertiary Period (After 8 Days)/Rehabilitation
39 Rehabilitation Strategies in Polytrauma . . . . . . . . . . . . . . . . . . . . 567
Roman Pfeifer
40 Treatment of Fracture-Related Infections . . . . . . . . . . . . . . . . . . 573
Mario Morgenstern, Martin Clauss, Parham Sendi,
Dieter Cadosch, Rik Osinga, and Willem-Jan Metsemakers
41 Management of Aseptic Malunions and Nonunions . . . . . . . . . . 583
Jeffrey O. Anglen
42 Strategies for Visceral Complications . . . . . . . . . . . . . . . . . . . . . . 607
Hans-Peter Simmen, Carina Eva Maria Pothmann,
Florin Allemann, Hans-Christoph Pape, and Valentin Neuhaus
xii Contents
43 Rehabilitation: Soft Tissue Coverage . . . . . . . . . . . . . . . . . . . . . . 619
Inga S. Besmens and Maurizio Calcagni
44 Principles of Surgical Patient Safety . . . . . . . . . . . . . . . . . . . . . . . 631
Philip F. Stahel and Vincent P. Stahel
45 Psychiatric Issues in the Treatment of Severe Trauma . . . . . . . . 641
Carol S. North and Fatih Canan
46 Rehabilitation: Long-Term Outcome and Quality of Life . . . . . 661
Boris A. Zelle, Jose M. Gutierrez-Naranjo,
Gautham Prabhakar, and Gustavo J. Almeida
