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Orthopedic and musculoskeletal injuries comprise a substantial part of disaster scenarios. Treatment requires a coordinated approach between medical professionals and local emergency management officials. It involves safe extraction of patients from life-threatening environments with transfer to an associated treatment facility. This can range from a triage facility up to a tertiary care center, depending on the number of patients affected and the available facilities and resources that are functioning at the time of the incident.1

Initial Assessment

Initial presentation and management of the trauma patient with orthopedic injuries begins with a thorough assessment of life-threatening conditions. Evaluation of airway, breathing, and acute bleeding emergencies allow for prompt recognition of critical injuries. Assessment and treatment via advanced cardiac life support and advanced trauma life support protocols enable the care teams to appropriately risk stratify and triage patients according to the needs for care. A team-based approach allows for appropriate division of responsibilities. The patient’s airway and breathing should be assessed first. Once performed, a thorough head-to-toe assessment should be carried out to evaluate for any injury, deformity or pain location. For fluid resuscitation, the patient should receive two large-bore IV access points. Once care has been established and patients initially stabilized, specific treatment can be implemented.

A thorough secondary survey should be performed by the treatment team once the patient is initially stabilized. The extremities should be examined for any deformity. Each extremity should be physically palpated and noted for tenderness and evidence of pain. The color and condition of the skin should be noted, and any areas of soft tissue disruption or bleeding should be treated with saline irrigation and bandaging. The chest wall and shoulders should be palpated with the patient performing deep inspiration and exhalation to examine for chest wall injuries. The pelvis should be compressed and distracted from the level of the iliac wing to examine for crepitus and motion, which may indicate underlying fracture. The patient should be asked to move each extremity and neurovascular status should be assessed for sensation, movement, and pulses.

Once the secondary survey has been completed, diagnostic imaging should be ordered. Radiographs of the affected areas should be obtained, starting with a single view chest and pelvis as per standard trauma protocols. The affected extremity should be examined above and below the area of injury to evaluate for bony or ligamentous injury. In the setting of an open fracture, IV antibiotics and tetanus toxoid should be administered, and resuscitation of the patient should continue while the treatment plan is being developed.


Open fractures can be a potentially devastating injury that can result in excessive hemorrhage and life-threatening infection, sepsis, and potentially amputation. Open fractures result when a fracture, including bone, hematoma, and soft tissue becomes exposed to the outside environment. Disruptions in the integrity of the skin ...

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