The Multiply Injured Patient



Multiply injured patients have to be treated according to an individual therapy regime. This regime has to include the urgent treatment of life-threatening injuries as well as extremity fracture care and reconstruction of soft tissue injuries.

The classification of patients into the four subgroups “stable,” “borderline,” “unstable,” and “in extremis” is helpful for the determination of an adapted treatment strategy. These categories are based on the patient’s physiological status, the ISS, and specific injury combinations.

Fractures of stable patients should be treated by initial definitive osteosynthesis.

The treatment regime of borderline patients should be a staged approach with periodically reassessment of the patient’s physiological state. In case of deterioration, the surgical regime should be changed into a damage control strategy.

In unstable patients damage control procedures are favored to stop the bleeding. Definitive fracture care can be performed after stabilization.

The treatment of patients “in extremis” should be strictly limited to lifesaving procedures.

The difficult decision between amputation and salvage of severely injured extremities should be based on the injury itself but as well on the physical state of the patient. The basic rule “life before limb” should absolutely hold true.


Injury Severity Score External Fixator Injured Patient Tibial Fracture Multiple Organ Dysfunction Syndrome 
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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of Orthopaedic TraumaUniversity of Aachen Medical CenterAachenGermany

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