Polytrauma is a leading cause of death in developing countries like India. Although during the last decade, India has developed in science and technology to great extent, still we need more development in the condition of Roads and Traffic. Every year there had been thousands of death resulting from high-velocity impacts. In our experience, a motorbike accident is a major cause of death resulting from polytrauma in our country.
‘Polytrauma’ is a medical term that is defined as a clinical state following an injury to the body leading to profound physiometabolic changes involving a multisystem. It is also defined as –
- Two major system injury + One major Limb injury
- One Major system injury + Two major Limb injury
- One Major system injury + One Open grade III skeletal injury
- Unstable pelvic fracture with associated visceral injury
Suffering from polytrauma may range from a few days of hospital stay to death. Polytrauma deaths happen in a patterned manner which can be said as three peaks of death after Polytrauma. The first peak is seen within minutes due to major neurological or vascular injury, medical treatment can rarely improve outcome. The second peak occurs during the “Golden Hour”. It can be due to intracranial hematoma, major thoracic, or abdominal injury. This is the time for the primary focus of intervention for the Advanced Trauma Life Support (ATLS) methodology. The third peak occurs after days or weeks which are due to sepsis or multiple organ failure.
As an Orthopedic surgeon, we have to deal with many trauma patients in our hospital every day. Fracture of limbs is the most commonly found damage that occurs from high-velocity injury. Patients of the younger age group are the most common sufferers from road traffic accidents. Head injuries are commonly associated findings we frequently deal with. The emergency team has to stabilize the patients once they enter the hospital. ATLS guidelines are strictly followed in our setup. In severely Polytraumatised patients we follow the protocol of “Damage Control Orthopedics” which is an approach that contains and stabilizes orthopedic injury, so that patient’s overall physiology can improve. Its purpose is to avoid worsening of the patient’s condition by the “Second hit” of a major orthopedic procedure and to delay definitive fracture repair until a time when the overall condition of the patient is optimized. Minimally invasive surgical techniques such as external fixation are used initially. Damage control focuses on the control of hemorrhage management of soft tissue injury and achievement of provisional fracture stability.
Common surgeries that are performed at our setup for trauma patients are intramedullary nailing of bones, plating, spinal surgeries, plastic surgery procedures, state of the art rehabilitation, and physiotherapy procedures. Use intra-operative X-ray is a very important tool which we commonly use to see a perfect alignment of bones and for better fixation. 24-hour support from the blood bank is of great help for us for better management of patients.
All said and done, the impact of polytrauma on the patient and their family both financially and psychologically most of the time is irreparable. The best way to solve this problem is to prevent polytrauma. Awareness amongst the public and society regarding the need of wearing a helmet, avoiding over speed, wearing a seat belt, avoid phones while driving, to follow traffic rules are very important steps. Young people are the most vulnerable group to suffer from polytrauma following road traffic accidents. There should be frequent interaction between experts and young age groups at school or college levels so that all grow as a responsible human being to the society. Strict rules and punishments should be enforced to the breakers of the law. Technology should be properly used to limit the speed of vehicles.
As a medical professional it gives us immense pleasure to see one patient returning to normal life after being treated for polytrauma. But rather than this, it’s very difficult to accept the loss of a person following trauma and the impact it leaves to family and friends. The essence of safety and prevention of trauma is to live healthily.