TRAUMA

(INJURY)

DEFINITION OF TRAUMA

Damage or injury refers to the effects on the human body of an external factor (mechanical, physical, chemical, radioactive, X-ray, electrical, etc.) that disrupts the structure and integrity of tissues and the normal course of physiological processes.

Depending on the nature of the damaged tissue, injuries are classified as cutaneous (bruises, wounds), subcutaneous (ligament ruptures, bone fractures, etc.), and cavity-related (bruises, hemorrhages/bleeding in the chest, abdomen, or joints).

Injuries are divided into direct and indirect depending on the point of force application. They can be single (e.g., transverse femoral fractures), multiple (multiple rib fractures), concomitant (pelvic fracture with bladder rupture), or combined (e.g., hip fracture along with frostbite of the foot).

The effect of the mechanical factor causing the damage manifests as compression, stretching, breaking, bending, or torsion, thereby damaging the tissue section in the area of force application. Injuries are open when the integrity of the skin or mucous membranes is broken, and closed when there is tissue and organ damage under intact skin and mucous membranes.

 

TYPES OF INJURY

The severity of an injury is classified as severe, moderate, and mild (minor).

• Severe injuries are those that cause significant health problems and lead to the loss of ability to exercise or play sports for more than 30 days. Patients require long-term hospital treatment by orthopedics and traumatology specialists.
• Moderate injuries are injuries with pronounced changes in the body that cause inability to exercise or sports limitations for 10 to 30 days. Children with moderate sports injuries are also treated by pediatric orthopedics and traumatology.
• Minor (mild) injuries are injuries that do not cause significant dysfunction in the body and do not result in a loss of general and athletic performance. These include abrasions, superficial wounds, small bruises, first-degree sprains, etc., which only require basic first aid. It may involve a combination of doctor-prescribed treatment (up to 10 days) with training and low-intensity activities.

In addition, there are acute and chronic injuries:

• Acute injuries are the result of the sudden impact of a traumatic factor.
• Chronic injuries are the result of the repetitive impact of the same traumatic factor on a specific area of the body.
• Another type of injury is microtrauma. These are damages sustained by tissue cells as a result of a single (or repetitive minor) impact that slightly exceeds the physiological limits of tissue resistance, leading to disruption of their structure and function (such as prolonged load on the developing bodies of children and adolescents).

INJURIES AND SHOCK

Injuries can be categorized statistically based on the similar conditions under which they occur in people of different ages. Depending on these conditions, there are domestic, industrial, sports, and street injuries.

Shock is a rapidly developing, critical condition characterized by progressive failure of life support systems, resulting in acute circulatory failure, acute respiratory failure, microcirculation disorders, and tissue hypoxia, causing dysfunction of all physiological systems.

Every year, 10 million people worldwide sustain serious injuries, and 250,000 die from shock. In wartime—termed “traumatic epidemics”—60% to 70% of the wounded die of shock on the battlefield. Global statistics show that for every 1,000 seriously injured, 100 people die from traumatic shock.

Depending on the cause, the types of shock are:

1. Traumatic shock:
   • As a result of mechanical injury:
     • Wounds
     • Bone fractures
     • Crush syndrome (long-term tissue compression)
   • Burn injuries:
     • Thermal
     • Chemical
   • Cold-induced shock (hypothermic shock)
   • Electric shock
   • Radiation shock
2. Hemorrhagic or hypovolemic shock:
   • Acute blood loss (hemorrhage)
   • Acute fluid loss (dehydration)
3. Septic (bacterial and toxic) shock
4. Anaphylactic shock
5. Cardiogenic shock:
   • Myocardial infarction
   • Acute heart failure
6. Transfusion shock:
   • Incompatibility of blood groups or Rh factor

Depending on the rate of development of shock events:

Primary shock – occurs during or immediately after the injury.

Secondary shock – occurs several hours after the injury.

Predisposing factors for shock development:

These factors, when present before or during exposure to traumatic agents, decrease the body’s overall resistance, promote the development of shock, and determine its severity.

1. Chronic debilitating diseases – vitamin deficiency, tuberculosis, anemia.
2. Hypothermia (cold exposure).
3. Hyperthermia (overheating).
4. Starvation.
5. Blood loss.
6. Severe emotional stress (nervous shock).
7. Ionizing radiation.
8. Inadequate immobilization during transport and insufficient anesthesia.
9. Surgical intervention for severe injuries, especially gunshot wounds.

CLASSIFICATION OF WOUNDS

A wound is defined as damage that violates the integrity of the skin, mucous membranes, and sometimes deep tissues, accompanied by pain, bleeding, and shock.

Wounds can be incised, punctured, crushed, lacerated, or bitten. Gunshot wounds are the result of bullets or shrapnel. They can be through-and-through when there are both entry and exit wounds; blind when the bullet or fragment remains embedded in the tissues; or tangential when the bullet or fragment flies along a tangent, damaging only the skin and soft tissues.

Incised and punctured wounds have a small area of damage and smooth edges; the walls of the wounds remain viable, bleed less, and are less prone to infection compared to others. Punctured penetrating wounds with a small skin or mucosal entry site can be of significant depth and pose a greater danger due to the possibility of internal organ damage and the introduction of infections, which can lead to peritonitis and sepsis. Lacerated wounds have uneven depth and are accompanied by bruising and crushing of soft tissues. Lacerated, torn, and crushed wounds are characterized by complex shapes, irregular edges, blood-soaked tissues, and significant areas of necrotic (dead) tissue, which create favorable conditions for the development of infection.

Torn wounds occur during severe mechanical trauma, often accompanied by skin avulsion, damage to tendons, muscles, and blood vessels, and are highly contaminated. Bitten wounds are always contaminated with saliva. Due to the presence of necrotic tissue over a significant area, they create favorable conditions for infection to develop.

FRACTURES

A fracture is a complete or partial disruption of bone integrity. Fractures can be closed (without damage to the integrity of the skin and mucous membranes), open (with damage to the integrity of the skin), non-displaced (bone fragments remain in place), or displaced (fragments shift depending on the direction of the moving force and muscle contractions).

Fractures are observed during sudden movements, falls from heights, or impacts. Fractures consisting of only two fragments are called simple fractures, while fractures with multiple fragments are called comminuted (multiple) fractures. Multiple bone fractures can occur in accidents, earthquakes, and disaster areas. The most severe fractures are those associated with burns and radiation injuries.

Fractures resulting from bullets or shrapnel are called gunshot fractures. These are characterized by the shattering of bone into large or small fragments, severe soft tissue destruction in the fracture zone, or traumatic amputation of a limb segment.

The main symptoms of fractures are pain, swelling, bruising, abnormal mobility at the fracture site, and loss of limb function. In open fractures, bone fragments can be seen in the wound. Fractures of limb bones are accompanied by shortening and deformity of the limb. Rib fractures can make breathing difficult, and a bone crepitus (grating sound of rib fragments) can be felt or heard at the fracture site. Fractures of the pelvic and spinal bones are often accompanied by urinary disorders and movement deficits in the lower extremities. Skull fractures are often accompanied by bleeding from the ears.

In severe cases, fractures are accompanied by shock. Shock develops especially in open fractures with arterial bleeding.

First Aid for Fractures

The treatment of bone fractures aims to sustain the life of the affected person, prevent potential complications, restore bone integrity and limb function, and enable the patient to return to work as soon as possible.

Crush Syndrome (Traumatic Toxicosis)

This injury is caused by the prolonged compression of soft tissues by heavy objects. Areas of necrosis develop in the compressed tissues, and decomposing toxic substances poison the body.

Immediately after release from pressure, the patient’s condition is satisfactory, but after 4-5 hours, sharp swelling and pain develop in the affected body part, the skin becomes purplish-blue, and body temperature rises sharply. If appropriate measures are not taken, death occurs on the 8th-9th day due to general systemic toxicosis.