Orthopedics focuses on the musculoskeletal system. Learn about the diagnosis, treatment, and rehabilitation of bone, joint, ligament, and muscle conditions.
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Overview and definition
Trauma treatment is a race against time. Always prioritize life over limb. This procedure means the surgeon will first resolve the issues that will kill the patient in minutes (like a bleeding liver), then the issues that will kill in hours (like a perforated bowel), and finally the issues that affect quality of life (like a broken leg). Families who see a mangled leg and seek immediate treatment may find this hierarchy of treatment confusing, as they may not realize that internal bleeding is the true threat.
This section covers the surgical and non-surgical treatments for trauma. We will explain “Damage Control Surgery,” a strategy that saves patients who are too sick for a long operation. We will also discuss the Intensive Care Unit (ICU) phase, where the battle for recovery continues after the surgery is done.
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Non-Operative Management
Surprisingly, not all trauma requires surgery. In fact, many injuries to the liver, spleen, and kidney can heal on their own if the patient is stable. This is called Non-Operative Management (NOM).
The patient is monitored closely in the ICU with frequent blood tests and exams. If the bleeding stops and the organ heals, surgery is avoided. This saves the patient from a large incision and the risks of anesthesia. It is a testament to the body’s healing power and modern monitoring capabilities.
Damage Control Surgery
Orthopedics is a broad field that addresses conditions present from birth (congenital), those caused by injury (traumatic), and those that develop over time due to aging or wear and tear (degenerative).
The field is often divided into specialized areas of focus, allowing physicians to develop high-level expertise in specific parts of the body or types of conditions:
- Joint Reconstruction and Arthroplasty: Focuses on replacing damaged joints, particularly the hip and knee, due to arthritis.
- Sports Medicine: Deals with injuries related to physical activity, such as ligament tears, meniscus injuries, and rotator cuff problems.
- Spine Surgery: Addresses conditions affecting the vertebral column, including herniated discs, spinal stenosis, and scoliosis.
- Hand and Upper Extremity: Focuses on the complex network of small bones, tendons, and nerves in the hand, wrist, and elbow (e.g., carpal tunnel syndrome).
- Foot and Ankle: Manages issues ranging from bunions and flat feet to complex fractures and Achilles tendonitis.
- Orthopedic Trauma: Specializes in the management of severe fractures and dislocations, often resulting from accidents.
- Pediatric Orthopedics: Dedicated to treating musculoskeletal issues in growing children, such as clubfoot, hip dysplasia, and growth plate fractures.
- Musculoskeletal Oncology: A specialized field treating benign and malignant tumors of the bone and soft tissue.
For patients who are bleeding to death or in severe shock, a long, complex surgery is actually dangerous. Their body is too cold, their blood too acidic, and their clotting system has failed. This condition is called the “Lethal Triad.”
In these cases, surgeons use it. It is an abbreviated operation. The goal is simple: stop the bleeding and stop the contamination (leakage of bowel contents). The surgeon packs the belly with sponges to put pressure on the bleeding, staples off any holes in the intestine without reconnecting them, and leaves the abdomen open (covered with a temporary plastic seal). The patient is rushed to the ICU to remain warm and receive blood transfusions. Once they are stable—usually 24 to 48 hours later—they go back to the OR for the definitive repair.
Exploratory Laparotomy
This is the standard trauma operation for abdominal injuries. The surgeon makes a long vertical incision down the middle of the belly. gives them access to everything.
They “run the bowel,” inspecting every inch of the intestines for holes. They are the liver, spleen, and stomach. They repair what can be sewn, remove what is destroyed (like a shattered spleen), and wash out any blood or bacteria. They carry out a comprehensive search and elimination process for any injuries.
Thoracotomy and Chest Tubes
For chest trauma, a chest tube is the most common treatment. A tube is inserted between the ribs to drain blood (hemothorax) or air (pneumothorax), allowing the lung to re-expand.
In rare, dire circumstances, an emergency department thoracotomy is performed. If a patient arrives having just lost their pulse from a chest wound, the doctor cuts open the chest right in the ER bay. They can clamp the aorta to save blood for the brain, massage the heart directly to pump it, and sew up a hole in the heart. It is a heroic, last-ditch effort with a low survival rate, but it is the only hope for some.
Musculoskeletal symptoms are among the most common reasons patients seek medical attention. Because the system involves so many moving parts, symptoms can present in various ways. Recognizing early warning signs is crucial for preventing minor issues from becoming chronic, debilitating conditions.
Recognizing Orthopedic Symptoms
Pain is the most universal symptom in orthopedics, but the nature of the pain and accompanying signs provide vital clues to the underlying problem.
- Pain Characteristics:
- Mechanical Pain: Pain that worsens with movement or specific activities and improves with rest. This is typical of osteoarthritis or tendonitis.
- Night Pain: Pain that disrupts sleep can be a sign of inflammatory conditions or, in rare cases, bone tumors.
- Radiating Pain: Pain that shoots from the spine down the arm or leg (sciatica) usually indicates nerve compression.
- Swelling and Inflammation: Visible puffiness, redness, or warmth around a joint suggests inflammation. This can result from acute injury (bleeding into the joint) or from chronic conditions such as arthritis or bursitis.
- Stiffness and Reduced Range of Motion: Difficulty moving a joint through its full extent. This is a hallmark of arthritis (often worse in the morning) or “frozen shoulder” (adhesive capsulitis).
- Instability or “Giving Way”: A sensation that a joint (often the knee or ankle) is buckling or cannot support weight. This strongly suggests ligament damage or laxity.
- Locking or Catching: A mechanical sensation where a joint feels like it gets stuck in one position. In the knee, this often indicates a meniscus tear or a loose fragment of bone/cartilage floating in the joint space.
- Deformity: Visible changes in the shape of a limb, such as the bowing of legs, the development of a bunion, or the unnatural angle of a limb following a fracture.
- Numbness and Tingling: Often described as “pins and needles,” these symptoms indicate nerve involvement, such as in carpal tunnel syndrome or spinal disc herniation.
- Muscle Weakness: An inability to generate normal force, which can result from muscle atrophy (wasting), tendon tears, or nerve damage.
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Orthopedic Trauma Surgery
Once the patient is alive and stable, the orthopedic surgeons take over. They fix the broken bones. This might involve external fixators (metal frames on the outside of the leg) for temporary stability in sick patients.
Later, they perform internal fixation using titanium rods, plates, and screws to rebuild the shattered bones. The goal is to restore the anatomy so the patient can eventually walk and use their arms again.
The ICU Course
The Intensive Care Unit is where the “resuscitation” continues. Trauma patients often have multiple organ systems failing. They may be on a ventilator to help them breathe. They receive massive blood transfusions.
The ICU team manages the swelling that happens after trauma (“third spacing”). They fight infections that can set in from dirty wounds. They manage the intense pain of multiple fractures. Recovery here is measured in small victories: stabilizing blood pressure, waking up, breathing on one’s own.
Rehabilitation and Long-Term Recovery
Survivors of major trauma face a long road. Rehabilitation often starts in the ICU with passive movement to keep joints flexible. It moves to a rehab facility where patients relearn how to walk, eat, and dress.
Traumatic Brain Injury (TBI) patients may need speech and cognitive therapy. Amputees need to learn to use prosthetics. The psychological toll—PTSD, depression, and anxiety—is also significant and requires support. Recovery is not just about healing holes and bones; it’s about rebuilding a life that was shattered in an instant.
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FREQUENTLY ASKED QUESTIONS
Why did they leave the belly open?
Leaving the abdomen open prevents “Abdominal Compartment Syndrome.” After trauma, the intestines swell massively. If the surgeon sewed the skin tight, the pressure would crush the internal organs. The plastic cover allows the swelling to happen safely. It will be closed later when swelling goes down.
Tympanoplasty is highly successful, with success rates generally reported between 85% and 90% for closing the hole permanently.
Will the spleen grow back?
No. If the spleen is removed (splenectomy), it is gone. You can live without it, but you have a slightly higher risk of certain bacterial infections. You will need special vaccines to protect you.
How long does a liver laceration take to heal?
Most liver injuries stop bleeding quickly, but the actual tear can take 3 to 6 months to fully heal on scans. Patients usually have to avoid contact sports during this time.
What is "phantom pain"?
Amputees often feel pain or sensation in the limb that is no longer there. It is a real nerve phenomenon rooted in the brain’s map of the body. Medication and mirror therapy can help.
Is PTSD common after trauma?
Yes. Up to 30-40% of trauma survivors experience Post-Traumatic Stress Disorder. Flashbacks, fear of driving, or anxiety are common. Counseling is a vital part of the complete recovery plan.
Most patients report mild to moderate discomfort rather than severe pain. The anesthesia wears off gently, and pain medication is provided for home use to manage any soreness.
