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ACUTE LIMB ISCHEMIA FOR SKELETAL INJURIES– EDUCATIONAL CHALLENGE FOR ORTHOPAEDIC SURGEONS CLINICAL CASE PRESENTATION
Abstract
Acute limb ischemia associated with scheletal injury represent a challenging aspect of modern traumatology with high individual and social impact especially due to complications which require prolonged hospitalization, repeated surgery and considerable costs. That is why medical research is directed to establishing the most efficient diagnostic and therapeutic algorithms able to decrease the incidence of complications and promote optimal fracture healing. The purpose of this paper is to underline the importance of early proper surgical action in order to include this aspect into future therapeutical guidelines.Polytrauma patients need special therapeutic algorithms as their pathophysiology has particular features; two main elements must be taken into consideration- the complex systemic reaction with a dominant inflammatory component, and the necessity to prevent the “Second Hit’ phenomenon, thus generating supplementary rules to be followed adjacent to those addressed to each separate injury. An example illustrating the above-described standards is represented by a patient who has suffered a trauma of the distal third forearm by horse bite. We present the optimal treatment in this clinical case highlighting the particular principles of treating skeletal injuries associated with acute ischemia.When considering the skeletal trauma, certain landmarks must guide the treatment, such as: proper evaluation of the systemic impact of the skeletal injury, multidisciplinary approach of the patient and flexible monitoring and treatment of all injuries generating heamodinamical instability. Using the tools provided by the ERASMUS + research programme 2018-1-RO01-KA202-049233 “e- Training of orthopaedic professionals to decrease morbidity and mortality due to Complex Life Threatening Skeletal Injuries” ( E-Trauma), the authors underline which are the main aspects to be approached by modern orthopaedic training so as to improve the treatment of skeletal injuries.
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References6
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