Trauma surgery is a specialty of surgery and deals with the surgical treatment and restoration of traumatically damaged body structures and organs. Orthopedics is another subspecialty.
What is trauma surgery?
Trauma surgery is a specialty of surgery and deals with the surgical treatment and restoration of traumatically damaged body structures and organs. Trauma surgery is an important specialty in acute and emergency care. A trauma surgeon treats injuries to the musculoskeletal system. This includes soft tissue injuries to tendons and muscles as well as bone fractures. The transition to the specialty of orthopedics is fluid. For this reason, there is specialized training in Germany to become a “specialist in orthopedics and trauma surgery”. In addition to surgical treatment, this sub-specialty of surgery also deals with non-surgical treatment options and the aftercare and rehabilitation of injuries, as well as their sequelae and secondary conditions. The term trauma surgery is also known by the synonym reconstructive surgery.
Treatments and therapies
Trauma patients are admitted to the trauma units of the relevant hospitals. The treatment spectrum ranges from minor cuts to life-threatening, severe multiple injuries, polytrauma. At this point, spinal, pelvic and neurosurgery are used. Physicians from other specialties are available to care for seriously injured patients in addition to emergency physicians and trauma surgeons. Lightly injured accident victims are treated in the outpatient clinic. The doctors splint slightly displaced and non-displaced fractures, disinfect, treat and suture wounds. They examine the surrounding nerve, vascular and tendon structures to determine the extent to which they are affected by the accident injury. These outpatient procedures are performed under conduction anesthesia or local anesthesia. This area also includes sports injuries, which are treated with minimally invasive arthroscopic techniques. One specialty is hand and foot surgery, as these parts of the body are most commonly affected by sports accidents. This includes reconstructive joint surgery using minimally invasive surgical techniques, as well as arthroscopically assisted ligament and fracture repair. Trauma surgeons are also responsible for corrective-reconstructive measures for malpositions, healing disorders and defective musculoskeletal systems. A professional nursing team is on hand to support them. This ensures that each patient receives individual care according to his or her age and injuries. Children are cared for first, while older patients who require several examinations before a final diagnosis is made are cared for by the nursing staff. Trauma surgery also includes outpatient follow-up care for patients who have suffered an industrial injury. Patients with private insurance have the option of going immediately to a hospital for trauma surgery, while those with public health insurance require a referral from an orthopedic surgeon or office-based surgeon if there is no emergency. Accident patients are often admitted with polytrauma. This involves simultaneous injuries to different parts of the body that are life-threatening if not treated in time. These patients are treated in specialized clinics that guarantee complete interdisciplinary treatment of all injuries in cooperation with the various surgical specialties. Immediate referral of the trauma patient to the right specialist hospital is an indispensable prerequisite for making the best possible use of the short window of opportunity available for promising treatment. Patients with polytrauma may present with spinal injuries, pelvic fractures, traumatic brain injury, and rib fractures including hematothorax (blood pooling in the thorax). Another major shock symptom is hypovolemia (decreased amount of blood in the circulation), which is treated with IV fluids or whole electrolyte solutions. This shock symptomatology can lead to capillary leak syndrome, which results in pulmonary edema that is initially reversible. A thickened alveolar wall (lung wall) forms, resulting in an increased right-to-left shunt, which in turn leads to hypoxia (oxygen deficiency) and hypercapnia (increased level of carbon dioxide in the blood).The accident patient is regularly threatened with respiratory insufficiency (respiratory arrest). Other intensive care problems in the first days after trauma surgery can include renal insufficiency and fat embolisms. To enable emergency physicians and trauma surgeons to act in a timely manner at the moment of the accident, the German Society for Trauma Surgery is striving to establish so-called trauma networks to optimize timely care for accident victims nationwide. Some hospitals are already part of a certified regional trauma network.
Diagnosis and examination methods
The emergency physician initiates general emergency medical treatment at the scene of the accident and ensures the life-sustaining vital functions of circulation and respiration. For some patients, however, all help comes too late if they have severe craniocerebral injuries or a ruptured aorta. These injuries lead to death while still at the scene of the accident. Patients who have survived the accident are admitted to the nearest trauma center and receive shock room care while still in the acute phase. All appropriate emergency interventions are performed during the “golden hour of shock”. Priority is given to diagnosis and treatment of polytraumatic injuries. Emergency physicians follow the elementary basis of “treat first what kills first.” In addition to ventilation and circulatory stabilization, the main focus is on stopping bleeding that affects the circulation, stabilization, and relieving pressure on the brain in case of swelling. Subsequent surgery is supported by intensive care treatments and imaging intervention. Imaging diagnostics begin immediately after completion of the acute phase and initiate the initial care phase. After a rapid and reliable diagnosis, life-saving therapeutic measures take place during this phase. Management in the shock room follows a treatment plan structured according to phases and priorities, which covers diagnosis, therapy and assessment (evaluation) of the trauma patient. The concept of Advanced Trauma Life Support (ATLS), which allows multi-slice spiral computed tomography (MSCT), is used in many hospitals. Diagnostic imaging is becoming increasingly important. In addition to whole-body computed tomography, MRI (magnetic resonance imaging) is also available as a cross-sectional imaging technique. Projection radiography establishes residual osseous (affecting the bone) findings and the severity of injuries. MRI and CT record the spinal and intracranial structures through non-overlapping cross-sectional images of various projections. Magnetic resonance imaging enables trauma surgeons to make sensitive neuroanatomic assignments to the indicated.
