Traumatic diseases include a wide range of injuries resulting from external forces, affecting physical and mental health. The document outlines types of trauma (acute vs chronic), mechanisms of injury, clinical manifestations, and management strategies, including resuscitation and rehabilitation. It emphasizes the importance of timely treatment to prevent complications such as malunion and chronic osteomyelitis.

1. Traumatic Diseases
Amrut Prasad Behera
M2156

2. Introduction
• Traumatic diseases encompass a broad spectrum of
injuries and conditions that arise from external
forces, affecting both physical health and sometimes
mental well-being until recovery, handicap or death.

3. Factors
• Grade of severity
• Localisation of the injuries
• Number of traumatic focals
• Patient’s age
• Patient’s individual response to trauma
• Comorbidities

4. Evolution
• I – acute period (from minutes to 48 hr)
• 1st
phase- instability of vital organs function (1st
6 hrs)- traumatic shock
• 2nd
phase- relative stability of vital organ function
: 24hr from trauma onset
• 3rd
phase- stable adaptation of the vital organs
function; (24-48hr)

5. Evolution
• II- Period of clinical manifestations (from the 3rd
day till 28-30
days)
• 1st
phase - catabolic lysis and absorption of necrotic tissue.
• 2nd
phase- anabolic generations
• Early stage (14 days)- proliferation of the conjunctive tissue,
begins infections process
• Tardive stage- weeks to months- ossification of bones, sclerosis
of conjunctive tissue

6. Evolution
• III- Rehabilitation period (Months- years)-
anatomical and functional recovery –handicapped
or incomplete, social and professional
rehabilitation

7. Type of Trauma – Acute and
Chronic forms
• Acute trauma - refers to injuries that occur suddenly due
to a specific event or accident.
• Onset: Immediate; the injury happens at a specific
point in time.
• Causes: Often results from falls, collisions, sports
injuries, or violent events (e.g., fractures, sprains,
contusions).
• Symptoms: Sudden pain, swelling, bruising, and loss
of function are common. Symptoms are typically
intense at the time of the injury.
• Healing Time: Generally has a defined recovery
period, ranging from weeks to months, depending
on the severity.

8. Chronic Trauma
• Chronic trauma refers to injuries or conditions that develop
gradually over time, often due to repetitive stress or overuse.
• Characteristics:
• Onset: Gradual; symptoms may develop slowly and can
worsen over time.
• Causes: Often results from repetitive movements, poor
biomechanics, or prolonged exposure to stressors (e.g.,
tendinitis, stress fractures).
• Symptoms: Persistent pain, stiffness, swelling, and decreased
function that may fluctuate in intensity but do not occur
suddenly.
• Healing Time: Recovery can be prolonged and may require
lifestyle changes, rehabilitation, and ongoing management.
• Examples: Tendinitis from repetitive motions, osteoarthritis
from wear and tear, carpal tunnel syndrome from overuse.

9. Acute Trauma- Fracture
• Break in the surface of a bone, either across its
cortex or through its articular surface.
• Types-
• Simple or compound
• Based on fracture line- incomplete or
complete which can be undisplaced or
displaced
• Based on fracture patter-
Transverse/oblique, Comminuted, Bone loss
• Atypical Fractures- Greenstick fractures,
impacted fractures, pathological fracture

10. Mechanism of Injury
Age Common modes of injury Examples
Children FOOP usually while playing or from
height
# Clavicle, # and d/L of upper limb
bones
Adults Fall from height
Driving Injuries RTA
Sports injuries
Assaults
Upper Limb injuries, spine injuries
Cervical spine Injury
Whiplash injury
Dashboard injury
Ankle Shoulder elbow injury
Long bone fracture
Elderly Trivial Fall Coll’s fracture
Fracture neck of Femur, Pelvis, etc

11. Clinical
Features
• Pain- very subjective and first complaint
• Swelling- soft tissue injury, medullary bleeding
and reactionary hemorrhage.
• Specific signs
• Deformity- seen/w displaced # with varying
severity
• Abnormal Mobility
• Crepitus
• Asymmetrical shortening or lengthening of
long bones

12. Clinical
Manifestations
• Neurovascular Injuries- #
Supracondylar in Children
• 5 Ps of impending vascular
damage-
• Pain
• Pallor
• Paresthesia
• Pulselessness
• Paralysis

13. Investigations
• Radiological Investigations
• X-Rays- m/c and m/f done
• Minimum 2 views AP/Lat and more
views advised depending upon the
case
• Helps to confirm Dx
• Helps to confirm fracture dislocations
• Helps in medicolegal studies
• CT- most helpful in dx # skull base, pelvis,
spine
• MRI- DX any fracture, identify sift tissue and
ligament injury

14. Management
of Simple
Fractures
• Conservative Methods-
slings, strapping, plaster slabs, rest
and NSAIDs

15. Management By Closed
fracture reduction
• Resuscitation- A-F management guidelines
• Airway, Blood circulation fluids, CNS, Digestive system, Excretory system, Fracture management
• Reduction- # segment reduction under GA if displaced
• Closed reduction- for simple fractures. Traction and counter traction method.
Risk of malunion
• Open Reduction- if the above method fails
• Retention- stability of the fracture site until is it united.
Done by- POP splints, casts
• Rehabilitation- Physiotherapy and exercise to regain ROM and muscle tone.

16. Approach to
Polytrauma
case
• Initial Evaluation- ABCDEFGH
• Secondary Evaluation- post
resuscitation, # are splinted to
manage later
• Exception- 1⁰ IF done in
ipsilateral fractures and
multisystem injuries
• Dislocations are promptly
reduced

17. Contd.
Area Involved Type of dislocation
Spine Ant. C5 over C6
Upper Limb
• Shoulder joint
• Elbow joint
• Wrist dislocation
• Kaplan’s injury
Anterior/Posterior
Posterior
Perilunar, Lunar
Carpometacarpal joint of the thumb
Lower limb
• Hip dislocation
• Knee joint
• Patella
• Ankle
• Foot
Ant/Posterior/ central
Posterior
Lateral dislocation
Anterolateral
Intertarsal and tarsometatarsal

18. Complications
• Acute- Injury to the peripheral nerve and
vessels can occur, e.g, sciatic nerve palsy
in posterior dislocation of hip.
• Chronic-
• unreducted dislocation
• Recurrent dislocation
• Traumatic osteoarthritis
• Joint stiffness
• Avascular necrosis
• Myositis ossificans- hypertrophic
calcification of muscle

19. Complication of Fractures
Acute Chronic Complication peculiar to open #
• Shock (hypovolemic or
neurologic)
• ARDS
• Thromboembolism
• Neurovascular injuries
1. Radial N. Palsy in
humerus shaft #
2. Sicatic N Palsy in post
d/L of hip
3. Supracondylar #
causing brachial
artery injury
• Acute Volkmann’s ischemia
• Crush syndrome
• DVT
• Delayed union
• Nonunion
• Malunion
• Shortening
• Growth disturbances
• Avascular necrosis
• Joint stiffness
• Post-traumatic arthritis
• Volkmann’s ischemic contraction
• Myositis ossificans
• Infection
• Chronic osteomyelitis
• Gas gangrene
• Tetanus
• Hypovolemic Shock
• Implant failure

20. Volkmann’s Ischemia or
Compartment Syndrome
• The most dreaded complication ranges from mild
ischemia to gangrene
• Early and prompt remedial measures is the key to
successful countering this problem.
• Defn- ischemic necrosis of the structure resulted due to
increased pressure within a confined body space.
• Ischemic pathogenesis increases the muscular
permeability leading to ↑intramuscular pressure
→↑ arterial compression → muscle necrosis →
Replaced by collagen → contractures
• 6Ps- Pain, Pallor, Pulselessness, paraesthesia, paralysis,
positive passive stretch test

21. Chronic Compartmental
Syndrome
• Pretibial pain induced by exercise seen in anterior compartment of leg in athletes.
• Suspect?
• Rest pressure of compartment >15mmHg
• >30mmHg during exercise
• >20 mmHg after 5 mins of exercise
• Management-
• Reduce level of activity
• If no relief then surgical decompression

22. Hematogenous Osteomyelitis
• Generic name for a whole spectrum of clinical
manifestations; the cause of which is infection of
bone and marrow from circulating organisms in
the blood from a distant source.
• Post-traumatic osteomyelitis follows open
fracture through open wound.

23. Common pathogens in Osteomyelitis
If Think
No risk factors Staph. Aureus
IV drug use S. Aureus or P seudomonas
Sickle cell anemia Salmonella
Hip replacement Staph. Epidermis (coagulase - staphylococcal)
Foot puncture wound Psuedomonas
Chronic S. aureus, Pseudomonas, enterobacteriae
Diabetic Mellitus Polymicrobial, pseudomonas, S aureus, streptococci,
anaerobes

24. Hematogenous Osteomyelitis
• History/PE
H/o Recent long bone fracture
+ Presents with localized bone pain and
tenderness along with warmth
+ swelling,
+ erythema
+ Limited ROM in adjacent joint
Systemic Symptoms-
*Fever chills
*Purulent drainage may be present

25. Investigations
• X-rays- initially –ve but may show
periosteal elevation in 10-14 days
• Bone scans but lacks specificity
• MRI- (test of choice) shows ↑ signal
in BM and associated soft tissue
injury
• Most accurate test- Bone aspiration
with Gram stain and culture
• Gold standard- Biopsy

26. Treatment
• Most accurate treatment-
• Surgical debridement of necrotic, infected bone followed by IV
antibiotics for 4-6 weeks
• Possible A/b therapy-
• Clindamycin + Ciprofloxacin
• Ampicillin/sulbactam or oxacillin/nafcillin(for MSSA)
• Vancomycin for MRSA
• Ceftriaxone or ciprofloxacin for gram -ve

27. Complication
• Chronic osteomyelitis
• Sepsis
• Septic arthritis
• Long standing draining sinus tract may lead to squamous cell
carcinoma (Marjolin ulcer).

28. Upper Limb Trauma
• Complication due to NEGLIGENC or Wrong treatment of fracture
• Malunion
• Nonunion
• Stiffness of the neighboring joint due to extensive fibrosis
• Myositis ossificans
• Neurological complications
• Vascular complications
• Compartment syndrome
• Persistent infections of the soft tissues and bones (Chronic Osteomyelitis)
• Functional loss of the limb due to wasting, stiffness, edema

29. Malunited Fracture
• Leads to
• Incongruity of the neighboring joints resulting in
pain and arthrosis
• Rotation and angulation may cause limitation of
movement
• Malunion of Radius and ulna → restriction in
supination and pronation
• Shortening asymmetrically
• Important for legs → limb length discrepancy
and bad limp.
If malunion and no symptoms → should not be corrected only
on the basis of cosmesis
If malunion and significant disability →surgical correction

30. Neglected Dislocations
• Old unreduced dislocation →articular cartilage degeneration
due to nourishment cut off.
Management-
1. Reduction by closed or open method
2. Arthroplasty
3. Arthrodesis

31. Neglected Fracture of the
shaft of humerus
• C/p- Malunion or nonunion
• Nonunion- due to inadequate immobilization, destraction
of the fracture and soft tissue interposition.
• Treatment- Internal Fixation by plating, bone grafting required
• Osteoporotic bone needs locking compression plate

32. Neglected
Clavicle
fracture
• M/c Malunion
• 10% nonunion
• Treatment – Dynamic compression
Plate with Bone grafting if
necessary

37. Neglected Physeal
Injuries
• Untreated for >3 weeks
• In children: 2-3 healing progresses as
such that reduction can cause damage
to growth plate and will develop
deformity within few months or a
year.

39. Neglected Lower Limb trauma
• Neck of femur, miscellaneous and other fractures of femur
• Neglected fracture neck femur is almost always a nonunion.
• Management- Valgus Osteotomy for Nonunion of Fracture Neck Femur in Adults : internal fixation of fracture complication
• Causes of Nonunion:
• Avascularity of the femur head
• Cambium layer of periosteum is missing so no callus
physiological- if callus to be formed at neck of femur, it will restrict acetabular movement.
• Unsatisfactory reduction
• Posterior communication
• Age and osteoporosis contributary factors
• Poor placement of implants
• Shearing force

40. Treatment
• Younger patients- osteosyntheis
• Valgus osteotomy
• Free or vascularized fibular graft
• Quadratus femoris muscle pedicle
graft
• Combined osteotomy and fibular graft

43. Thank you.