Musculoskeletal Trauma
The bony skeleton provides the supporting framework for the human body. Its 206 bones are subject to many stressors, which may result in fractures. Fractures vary in complexity and potential harm to the body. Simple fractures occur with no break from the bone to the outside of the body, whereas compound fractures have an external wound, thus creating contamination of the fracture. Complete fractures occur when bone continuity is completely interrupted, whereas partial fractures (incomplete) interrupt only a portion of bone continuity.
Alcohol consumption is an important cofactor when it is associated with trauma. Acute alcohol intoxication may compound a head or musculoskeletal injury by masking the effects of pain and immobility. In addition, it may modify the patient’s ability to tolerate multiple traumas by having a direct cardiodepressant effect. Profound hypotension and bradycardia result from acute blood loss in the patient with musculoskeletal injury who has been drinking heavily.
Many complications can occur as a result of musculoskeletal trauma. Arterial damage and bleeding can lead to hypovolemic shock. Nonunion of bones, avascular necrosis, bone necrosis, and peripheral nerve damage can lead to lasting deformities and disabilities. Rhabdomyolysis (destruction of skeletal muscle) can lead to renal failure, and bone injury can lead to fat emboli. Infection is the most common complication of trauma and can lead to sepsis and septic shock.
Musculoskeletal injuries can involve an acute phase and a chronic phase. The acute phase involves the medical evaluation and resuscitation of the patient. Surgery is frequently required to stabilize the patient and the patient usually needs further observation to look for other problems. The chronic phase represents the period of time when the patient is medically stable but requires significant rehabilitation and therapy services in order to gain functional capacity.
Traumatic injuries can be intentional (assaults, gunshot wounds, stab wounds) or unintentional (falls, motor vehicle crashes [MVCs]). Multiple traumas that result from an MVC often involve several systems of the body and musculoskeletal injury. Falls and MVCs account for a high percentage of the fractures seen today. Children at play take falls as a matter of course and only occasionally suffer fractures. Their most common fractures are of the clavicle. Adults who fall more often fracture a hip or wrist. Osteoporosis increases the likelihood of fractures from a fall; it even sometimes causes a fracture from a slight shift in the body’s position, which then results in a fall, rather than the reverse.
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Journal of Orthopedic Oncology