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Orthopedic Patients

  • Russell K. Stewart
  • Steven L. Oreck
  • Lucas Teske
  • Brian R. WatermanEmail author
Chapter

Abstract

Isolated or combined musculoskeletal trauma comprises a significant percentage of all injuries in both civilian and military populations. For both groups, the use of personal protective equipment reduces the rate and severity of injuries but also increases the percentage of orthopedic injuries. Long-distance aeromedical evacuation (AE) for these patients presents several challenges. Some fracture stabilization techniques used on the ground, such as free weight traction and military anti-shock trousers (MAST), should not be used during AE. Other methods are appropriate during AE, although circumferential casts that are tight should be split prior to flight. In-flight complications in stable orthopedic patients are relatively rare more than 72 hours after injury or surgery and include fat embolism syndrome, compartment syndrome, and pulmonary venous thromboembolism. However, they can have limb- and life-threatening consequences if not recognized and appropriately treated. Adequate planning and early identification are crucial for improving outcomes for patients who require AE. Whenever possible, long-distance AE for orthopedic patients should be delayed until 72 hours after injury or surgery to minimize the risk of in-flight complications. After microvascular reattachment of a limb or digit, AE should be delayed for at least 7 days.

Keywords

Bone fractures Orthopedic complications In-flight emergencies Splinting Surgical site infection 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Russell K. Stewart
    • 1
  • Steven L. Oreck
    • 2
  • Lucas Teske
    • 3
  • Brian R. Waterman
    • 3
    Email author
  1. 1.Wake Forest School of MedicineWinston-SalemUSA
  2. 2.CAPT, MC, USN (FMF) (ret.), Department of HistoryUniversity of Wisconsin-MadisonMadisonUSA
  3. 3.Department of Orthopedic SurgeryWake Forest Baptist HealthWinston SalemUSA

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