Polytrauma – A Nightmare for the Patient

Polytrauma is a leading cause of death in developing country like India. Although during the last decade, India has developed in science and technology to great extent, still we need more development in condition of Roads and Traffic. Every year there had been thousands of death resulting from high velocity impacts. In our experience motor bike accident is a major cause of death resulting from polytrauma in our country.
‘Polytrauma’ is a medical term which is defined as a clinical state following injury to the body leading to profound physiometabolic changes involving multisystem. It is also defined as –
  • Two major system injury + One major Limb injury
  • One Major system injury + Two major Limb injury
  • One Major system injury + One Open grade III skeletal injury
  • Unstable pelvic fracture with associated visceral injury

Suffering from polytrauma may range from few days of hospital stay to death. Polytrauma deaths happen in a patterned manner which can be said as three peaks of death after Polytrauma. First peak is seen within minutes due to major neurological or vascular injury, medical treatment can rarely improve outcome. Second peak occurs during “Golden Hour”. It can be due to intracranial hematoma, major thoracic or abdominal injury. This is the time for primary focus of intervention for the Advanced Trauma Life Support (ATLS) methodology. Third peak occurs after days or weeks which are due to sepsis or multiple organ failure.

As an Orthopedic surgeon, we have to deal with many trauma patient in our hospital every day. Fracture of limbs are most commonly found damage which occurs from high velocity injury. Patients of younger age group are most common sufferers from road traffic accidents. Head injury are commonly associated findings we frequently deal with.  Emergency team has to stabilize the patients once they enter the hospital.  ATLS guidelines are strictly followed in our setup. In severely Polytraumatised patients we follow the protocol of “Damage Control Orthopedics” which is an approach that contains and stabilizes orthopedic injury, so that patient’s overall physiology can improve. Its purpose is to avoid worsening of the patient’s condition by the “Second hit” of a major orthopedic procedure and to delay definitive fracture repair until a time when the overall condition of the patient is optimized. Minimally invasive surgical techniques such as external fixation are used initially. Damage control focuses on control of hemorrhage management of soft tissue injury and achievement of provisional fracture stability.
Common surgeries that are perform at our setup for trauma patients are intramedullary nailing of bones, plating, spinal surgeries, plastic surgery procedures, state of the art rehabilitation and physiotherapy procedures. Use of intra-operative X-ray is a very important tool which we commonly use to see perfect alignment of bones and for better fixation. 24 hour support from blood bank is of great help for us for better management of patients.
All said and done, the impact of polytrauma on patient and their family both financially and psychologically in most of the time is irreparable. Best way to solve this problem is to prevent polytrauma. Awareness amongst public and society regarding need of wearing helmet, avoiding over speed, wearing seat belt, avoid phone while driving, to follow traffic rules are very important steps. Young people are most vulnerable group to suffer from polytrauma following road traffic accident. There should be frequent interaction between experts and young age groups at school or college levels so that all grow as a responsible human being to the society. Strict rules and punishments should be enforced to the breakers of law. Technology should be properly used to limit speed of vehicles.
As a medical professional it gives us immense pleasure to see one patient returning to normal life after being treated for polytrauma. But rather than this, it’s very difficult to accept the loss of a person following trauma and the impact it leaves to family and friends. The essence of safety and prevention of trauma is to live healthy.

 

Dr. Samarjit Khanikar
Consultant – Orthopaedics and Joint replacements
Narayana Superspeciality Hospital, Guwahati

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