Associated Musculoskeletal Injuries

Severe central neurologic or axial skeletal trauma is commonly associated with high-energy extremity injuries. The most common injuries associated with spine trauma are head injuries (17 %), lower limb fractures (5.9 %), upper limb fractures (4.4 %), chest injuries (2.9 %), pelvic fractures (2.5 %), and abdominal injuries (1.5 %). The care of the multiply injured patient has improved substantially over the past several decades and led to higher survival rates. Damage-control orthopaedics, or temporizing treatment through rapid debridement of open wounds, restoration of tissue perfusion and limb circulation, stabilization of long bones, and, when possible, limb salvage using techniques has proven effective. Orthopaedic injuries including long bone fractures and vascular compromise due to compartment syndrome are important in initial stabilization and diagnosis and further complicate nursing care and mobilization. While timing of surgery for spine fractures is controversial, there is general consensus regarding several absolute indications for urgent surgical intervention. The most widely supported reason for early intervention is any progressive neurological deficit caused by spinal cord or root compression. Spinal dislocations associated with a neurological deficit or spinal kyphosis that compromises the overlying skin or patient positioning for non-spine procedures are also strong indications for urgent surgical intervention. Considerations for timing of decompression as well as stabilization are discussed and current evidence for outcomes in function and mortality are presented. Polytrauma in the setting of acute spinal injury is multifaceted and always interdisciplinary. It is most important for the general trauma surgeon, orthopaedic trauma surgeon, and spine surgeon to be in close communication to methodically coordinate each procedure so return to function can be optimized.