Trauma

[jw123]

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hey, i was just curious. I work on an ambulance and we took someone involved in a car crash that what looked like to me a crushed foot and ankle. When these type of patients come in when do you operate on them usually? i know it must depend on their condition but do they just normally stabalize the patient and then if thats the only injury they have you operate on them or do they have to wait a few days to have it operated in since its usually not life threatening. its kind of a wierd question but i just thought about it on the way back from the hospital

thanks

 

[jonwill]

hey, i was just curious. I work on an ambulance and we took someone involved in a car crash that what looked like to me a crushed foot and ankle. When these type of patients come in when do you operate on them usually? i know it must depend on their condition but do they just normally stabalize the patient and then if thats the only injury they have you operate on them or do they have to wait a few days to have it operated in since its usually not life threatening. its kind of a wierd question but i just thought about it on the way back from the hospital

thanks

It really depends on a lot of factors. Crush injuries often result in compartment syndrome which is an indication for emergent surgery. But, we wouldn't fix the bone at that time. We'd do fasciotomies. If it is an open fracture, we'd do an I&D but again would probably not fix the bones at that time either. Another problem we often run into with trauma is swelling. If we can get to the patient fairly quick, we can get a compression dressing on which will help us out.

All of that aside, trauma is not emergent. With things like ankle, calcaneal, or metatarsal fractures, we put a compression dressing on, keep the patient non-weightbearing, and do the case as an outpatient in 7-10 days. If it is an injury where bones are shattered, we'll generally do a staged procedure where we ex-fix the patient and internally fixate the patient at a later date if needed.