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Approach to the polytraumatized patient with musculoskeletal injuries.

The management of the multiply injured patient is a challenge for even experienced clinicians. Because many community hospitals lack a dedicated trauma team, it is often the orthopaedic surgeon who will direct treatment. Therefore, the orthopaedic surgeon must have an understanding of established guidelines for the evaluation, resuscitation, and care of the severely injured patient. Initial evaluation encompasses assessment and intervention for airway, breathing, circulation, disability (neurologic injury), and environmental and exposure considerations. Resuscitation requires not only administration of fluids, blood, and blood products but also emergent management of pelvic trauma and stabilization of long-bone fractures. Judicious early use of anterior pelvic external fixation can be lifesaving in many cases. The secondary survey, which is often neglected, must incorporate a thorough physical evaluation. Although the method of fracture stabilization is still controversial, most clinicians agree that early fixation offers many benefits, including early mobilization, improved pulmonary toilet, decreased cardiovascular risk, and improved psychological well-being. Without an understanding of the complexities of the multiply injured patient, delays in the diagnosis and treatment of a patient's injuries are likely to adversely affect outcome.

Engaging with younger patients

By John M. Purvis, MD

Let your pediatric patients bring out the kid in you

Some orthopaedists are less than comfortable with children while others more easily relate to them. If you are young at heart—or remember what it was like to play—you may have an easier time, but every orthopaedist can use the four Es—engagement, empathy, enlistment, and education—to facilitate communication with pediatric patients. This article focuses on ways to engage and empathize with pediatric patients and their parents.