Chapter 1. Trauma and evolution of its treatment modalities

Trauma

Trauma (or injury) is the impact on the body of various external factors that leads to a violation of the structure, anatomical integrity of tissues and physiological functions.

Injuries are divided into acute (the result of a momentary, sudden impact of an external factor) and chronic (as a result of constant and repeated exposure to the same traumatic agent on a certain part of the body).

Depending on the type of damaging factor, injuries are distinguished in mechanical, thermal, chemical, radiological, biological, etc. In this manual, mechanical and thermal injuries will be considered.

The effect of an external factor is influenced by the nature and duration of exposure, the direction of the traumatic force, the kinetic energy of the traumatic agent.

Mechanical injuries are classified by several characteristics depending on:

• the point of application of the force - direct (at the place of application of the force) and indirect (at a distance from the point of application of the force) (Fig. 1.1);
• the amount of kinetic energy acting on tissues - high-energy trauma (car accident, falling from a great height, gunshot wound) and law-energy trauma (Fig. 1.2);
• the action of mechanical force - compression, twisting, stretching, impact;
• the nature of tissue damage - bruise, rupture, fracture, dislocation, wound;
• the type of damaged areas of the body - cavity trauma (damage to the organs of the abdominal, thoracic cavities, cranial cavity) and skeletal trauma (damage to bones, joints, skeletal muscles);
• the number of damaged organs - isolated (damage to one internal organ or injury within one segment of the musculoskeletal system) and polytrauma (in turn, divided into multiple, concomitant and combined; this classification will be discussed in more detail in Section 4.1 "Polytrauma").

Fig. 1.1. Mechanisms of trauma: a) direct; b) indirect

Fig. 1.2. High-energy (a) and low-energy (b) trauma

Traumatism

Traumatism presents the aggregate of injuries in certain groups of the population or in a contingent of persons who are in the same environment, the same type of working and living conditions for a certain time span. There are causal relationships between external conditions (work, sports, features of everyday life, use of transport, etc.) and the condition of the body (nutrition, age, chronic diseases, climatic features), permitting to study and predict the nature and frequency of injuries in a certain contingent of people and take preventive measures (Table 1.1).

Children's traumatism is especially standing out, where, in addition to all the listed types (mainly non-industrial) injuries, there are labor (during childbirth) and school injuries (during the child's stay in school or a preschool organization, or en rout). When studying children's traumatism, the following age groups are described: infancy (up to one year), nursery (from one to three years), preschool (from three to seven years), school (from 7 to 16).

The injury rate is determined by the number of injuries per 100 or 1000 people for a certain period (month, year). The injury frequency rate at the enterprise is calculated by dividing the number of injury cases in the reporting period by the total number of employees.

Table 1.1. Types of traumatism

The highest injury rate is observed in men in the age range of 20-50 years, and in women - 30-60 years, and, for all age groups, men's traumatism rate is significantly higher comparing with women.

In Russia, the total number of injuries exceeds 10 million cases per year. The provision of medical assistance, treatment and rehabilitation of victims require the involvement of large funds, material, and human resources. Therefore, great attention should be paid to the prevention of injuries, the identification of their causes.

Industrial injuries are primarily associated with working conditions, serviceability of equipment, control over compliance with safety regulations. In non-occupational traumatism, the share of road traffic injuries is growing. Despite preventive measures, road traffic traumatism today presents a serious problem of global importance. The main role in the occurrence of road accidents belongs to the human factor: over 90% of injuries in road traffic accidents occur through the fault of people. Social tension in society, political events in the world have led to an increase in intentional and military injuries in recent years.

Evolution of trauma treatments

History

Traumatology as a kind of "system" of skills is one of the most ancient branches of human knowledge. During the excavations of the sites of ancient people, the skeletons with traces of trepanation holes in the skull, with amputated limbs, and healed fractures were discovered. The analysis of the findings has demonstrated that after injuries people were living relatively long, and, for the treatment of some injuries, they had already used reliable immobilization.