Extremity trauma

Background

• Can result in soft tissue, neurovascular, muscular, and ligamentous damage

Clinical Features

Limb salvage is based of several features (See calculator below):

• Age
• Severity of skeletal and soft tissue injury
• Severity of limb ischemia
• Duration of limb ischemia
• Severity of shock

Differential Diagnosis

Extremity trauma

• Compartment syndrome
• Contusion
• Crush syndrome
• Degloving injury
  • Morel-Lavallée lesion
  • Ring avulsion injury
• Fracture
  • Open fracture
• Laceration
• Myositis ossificans
• Open joint injury
• Peripheral nerve injury
• Rhabdomyolysis
• Tendon injury
• Vascular injury

Evaluation

Workup

• ATLS
• X-rays
• Trauma labs with close attention to K, Creat, and CK
• Consider CTA or conventional angiography if evidence for vascular compromise

Management

• ATLS protocols if unstable
• Consider use of tourniquet
  • Can be an excellent adjunct to control bleeding
• Tetanus
• Antibiotics
  • Cefazolin 2g IV
  • Consider adding Gentamycin or Tobramycin
• Additional treatments depending on specific findings

Disposition

• May require admission with trauma team with consultation from ortho and/or vascular surgery

See Also

• Compartment Syndrome
• Compartment Pressure Measurement
• Rhabdomyolysis
• Fractures (Main)
• Open Fracture

External Links

• MDCalc Mangled Extremity Severity Score (MESS)