Anesthesia considerations for musculoskeletal trauma
Objectives Review the anesthetic considerations for complex musculoskeletal injuries including pelvic and long-bone fractures, traumatic amputations, and crush syndrome. Discuss issues related to the timing of surgical fixation of specific fractures. Discuss the impact of anesthetic management on morbidity and mortality following hip fracture. Review the pathophysiology and anesthetic concerns relating to acute compartment syndrome, fat embolism, and complex regional pain syndrome. Summarize the postoperative concerns following musculoskeletal trauma, specifically pain and delirium. Introduction Musculoskeletal injury is common in the trauma patient. While bony fractures and muscular injuries can occur anywhere on the body, the extremities are disproportionately affected. Approximately 60% of multiple trauma patients with an Injury Severity Score (ISS) of ≥ 16 have extremity injury of some type, and 18% have both lower and upper extremity injuries. Over 30% of the same population will have two or more extremity fractures. Mechanism of injury is an important epidemiologic factor – for example, those in motor vehicle collisions (MVCs) have a significantly higher prevalence of extremity injury; similarly, due to improvements in battlefield medicine and body armor, modern military combatants have a dramatically reduced rate of fatal torso injury, meaning that while more survive, they have much higher rates of serious extremity injury. While patients with isolated extremity injuries typically go on to have very good outcomes, it has been shown that orthopedic and general health outcomes become significantly poorer if the same injury is present in a polytrauma patient.
