Orthopedics in Disasters Orthopedic Injuries in Natural Disasters and Mass Casualty Events 1st Edition by Nikolaj Wolfson, Alexander Lerner, Leonid Roshal ISBN 9783662489505 3662489503

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ISBN 10: 3662489503
ISBN 13: 9783662489505
Author: Nikolaj Wolfson, Alexander Lerner, Leonid Roshal

Orthopedics in Disasters Orthopedic Injuries in Natural Disasters and Mass Casualty Events 1st Edition Table of contents:

Part I: General Overview of Disaster and Mass Casualties Management: Organization

1: Introduction

2: Epidemiology and History of Natural Disasters and Mass Casualties

2.1 Introduction

2.2 The Study of Disasters and the History of Disaster Response

2.3 Terminology Used in Disaster Management

2.3.1 Hazard

2.3.2 Vulnerability

2.3.3 Capacity

2.3.4 Disaster Cycle

2.3.5 Mass Casualty

2.3.6 Humanitarian Crisis

2.3.7 Complex Emergency

2.4 Factors That Influence the Epidemiology of Disasters

2.4.1 Climate Change

2.4.2 Urbanization and Deforestation

2.4.3 Poverty

2.4.4 Political Instability

2.4.5 Conflict

2.4.6 Migration and Displacement of Vulnerable Populations

2.4.7 Failure of States to Develop Post-conflict

2.4.8 Global Finance and Trade Agreements

2.4.9 Failure of the International Community and Humanitarian Aid

References

3: Warfare Medicine: Historical Perspectives

3.1 War-related Orthopedic Injuries

3.1.1 Introduction

3.1.2 Ancient Warfare BC

3.1.3 Warfare AC

3.1.3.1 Napoleonic War (1803–1815)

3.1.3.2 The American Civil War (1861–1865)

3.1.3.3 Boer War (1899–1902)

3.1.3.4 World War I (1914–1918)

3.1.3.5 World War II (1939–1945)

3.1.3.6 Korean War (1950–1953)

3.1.3.7 Vietnam War (1959–1975)

3.1.3.8 Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (ODI)

3.2 Military Health System

3.2.1 Introduction

3.2.2 Role I–IV Levels of Care for NATO

3.2.3 Echelons I–V of Care for US Forces

3.2.4 Development of the Military Field Hospital

3.2.5 Development of the Mobile Army Surgical Hospital (MASH)

3.2.6 Development of the Forward Surgical Team (FST)

References

4: Emergency Medical Services

4.1 Introduction

4.2 EMS: What Is It and Why Does It Concern Me?

4.2.1 Mission

4.2.2 Community and EMS

4.2.3 Components of an EMS System

4.2.3.1 Dispatch

4.2.3.2 First Responders and Special Teams

4.2.3.3 Providers

4.2.3.4 Hospitals and Specialty Care Centers

4.2.3.5 Quality Improvement (QI)

4.3 Military and Civilian Innovation

4.4 Models of EMS Delivery

4.4.1 Provider Entities

4.4.2 Levels of Training

4.4.3 Physician Staffed Resources

4.4.4 Advanced Technician Staffed Resources

4.4.5 Basic Technician Staffed Resources

4.5 EMS in Practice

4.5.1 Normal Operations

4.5.2 Disaster Operations

4.5.3 Disaster Planning in EMS

4.6 Summary

5: Treatment Capabilities of Field Hospitals at War and Mass-­Casualty Disasters

5.1 Introduction

5.2 Field Hospitals: A Historical Perspective

5.3 Field Hospitals of the Israeli Medical Corps: Structure and Function

5.4 The Haiti Experience: An Airborne Field Hospital in Action

5.5 Summary

References

6: Role of Government and NGOs

6.1 Introduction

6.2 Stakeholders

6.2.1 Local Government

6.2.2 Military and Uniformed Services Groups

6.2.3 Foreign Responders

6.2.4 United Nations Affiliates

6.2.5 Global Professional Associations

6.2.6 Nongovernmental Organizations

6.2.6.1 The Main Issue with NGO Activities in Disaster

6.2.6.2 Government: NGO Collaboration

6.2.7 Hybrid Organizations

6.2.8 The Mass Media

References

7: Civilian Hospital Role in Mass Casualty Event (MCE)

7.1 Introduction

7.2 General Principles

7.2.1 Hospital Readiness and Preparedness

7.2.2 Management at the Hospital Level

7.2.3 Step-by-Step Management of Emergency Events at the Hospital Level

7.2.3.1 Phase 1: Preadmission Preparedness

Notification, Validation, and Decision-Making

Role Assignment

7.2.3.2 Phase 2: Management of the Emergency Event

7.2.3.3 Phase 3: Debriefing and Lessons Learned

7.2.3.4 Evaluation of the Model

7.2.4 Training International Teams for Mass Casualty Situations

7.2.4.1 Topics of Courses and Workshops

Organizing a Trauma System

Mass Casualty Situations (MCS)

7.2.5 Summary and Conclusion

7.3 Mass Casualties: Preparedness, Orthopedic Trauma Service, Hadassah Hebrew University Medical Ce

7.3.1 Rationale

7.3.1.1 Primary Blast Effect

7.3.1.2 Secondary Blast Effect

7.3.1.3 Tertiary Blast Effect

7.3.1.4 Quaternary Blast Effect

7.3.2 Preparedness

7.3.2.1 Surge Capacity

7.3.2.2 Triage

7.3.2.3 Damage Control Strategy

7.3.2.4 Information Centers

7.3.3 Diagnostics and Management

7.3.3.1 The Morning After

7.3.4 The Role of Orthopedic Surgery in Mass Casualty Events

7.3.5 Benefits and Risks

7.3.6 Summary

References

8: Individual Preparedness in Disaster Response

8.1 Introduction

8.2 Core Competencies

8.3 Psychosocial Competencies

8.4 New Challenges

8.5 The Americas

8.6 Europe

8.7 Asia-Pacific

8.8 International NGOs

8.9 Red Cross and Red Crescent Movement

8.10 Format of Training

8.11 United Nations Affiliates

8.12 Telemedicine

References

9: Orthopedic Equipment Needs in Disaster Setting

9.1 Introduction

9.2 General Equipment Needs for Initial Response Team

9.2.1 Portable Power Generator

9.2.2 Portable Sterilizator

9.2.3 Electrocauter Device

9.2.4 Tourniquets and Topical Hemostatic Agents

9.2.4.1 Tourniquets

9.2.4.2 Hemostatic Agents

9.2.5 Suction Device

9.2.6 Antibiotics, Analgesics, Tetanus Toxoids and/or Tetanus Immunoglobulins, and Irrigation Solu

9.2.7 Plaster of Paris (PoP) Cast, Padding, Elastic Bandage, and Cast Cutter

9.3 Wound Dressings Including Negative-Pressure Wound Therapy (Wound VAC System)

9.4 Skeletal Traction

9.5 Skin Traction

9.6 Basic Surgery Set, Suture Materials, Gigli Saw

9.7 Arm Sling

9.8 Orthopedic Equipment Needs for Secondary Response Team

9.8.1 External Fixation Set

9.8.2 Basic Orthopedic Instrument Set, Small and Large Fragment, Instrument Set for Nailing

9.8.3 Battery-Operated or Electric Power Drill

9.8.4 Orthopedic Implants

9.8.5 Dermatome

9.8.6 Assistive Device

References

Part II: General Overview of Disaster and Mass Casualties Management: Orthopedic Injuries of Specifi

10: Traumatic Injuries During Earthquakes

10.1 Earthquakes

10.1.1 Surgical Care in Natural Disasters

10.1.2 Surgical Care in Earthquakes

10.1.3 Orthopedic Care in Earthquakes

10.1.4 Ethical Considerations

10.1.5 Cultural Factors

10.2 The Main Types of Damage Caused by Earthquakes

10.2.1 Fractures

10.2.2 Amputation

10.2.3 Crush Injuries, Crush Syndrome, and Compartment Syndrome

10.2.4 Polytrauma and Multiple Trauma

10.2.5 Circulatory Shock

10.2.6 Concomitant Injury to the Brain

10.2.7 Combined Spinal Cord Injury

10.2.8 Combined Chest Trauma

10.2.9 Combined Abdominal Trauma

10.2.10 Concomitant Injury of the Musculoskeletal System

10.2.11 Combined Injury of Two or More Cavities

10.3 Discussion

References

11: Tsunami and Flood

11.1 Introduction

11.2 Type of Orthopedic Injury by Tsunami

11.3 The Infections and Treatment of Wounds

11.4 Communications and Cooperation

11.5 Medical Facility and Relief

11.6 Learning from Tsunami Experience and Damages

References

12: Nuclear Disasters

12.1 Introduction

12.2 Radiation Exposure and Pollution

12.3 History of Major Nuclear Reactor Accidents [3, 4]

12.4 Types of Radiation

12.4.1 Alpha Rays

12.4.2 Beta Rays

12.4.3 Gamma Rays (Almost Equal to X-Rays)

12.5 Half-Life of Radioactive Materials

12.6 Special Radiation Units

12.7 Outline of the Radiation Medicine [5]

12.8 Patients with External Radiation Exposure (Can Be Lethal)

12.9 Radiation Tissue Damage

12.9.1 Bone

12.9.2 Nerves and Muscle

12.9.3 Skin

12.10 Patients Contaminated with Radioactive Materials (Radionuclides)

12.11 Healthcare Workers’ Radiation Exposure

12.12 Healthcare Facility Management

References

13: Orthopedic Injuries in Transportation Disasters

13.1 Introduction

13.2 Survey

13.3 Injuries in Fatal Aircraft Accidents

13.4 Trauma System

13.4.1 Trauma System Components

13.4.2 Public Information, Education, and Injury Prevention

13.4.3 Human Resources

13.4.4 Prehospital

13.4.5 Communication System

13.4.6 Medical Direction

13.4.7 Triage and Transport

13.5 Conclusion and Orthopedic Surgeon Role

References

14: Terror-Related Trauma

14.1 Preface

14.2 Mechanism of Injury

14.2.1 Radiological Terrorism

14.2.2 Biological Terrorism

14.2.3 Chemical Terrorism

14.2.4 Conventional Terrorism

14.2.4.1 Primary Blast Injury

14.2.4.2 Secondary Blast Injury

14.2.4.3 Tertiary Blast Injury

14.2.4.4 Quaternary Blast Injury

14.3 Triage

14.4 Evaluation and Treatment

14.4.1 Patient Evaluation

14.4.2 Treatment: Damage Control Orthopedics

14.4.3 Treatment of Typical Injuries

14.4.3.1 Soft Tissue Injury

14.4.3.2 Fracture Fixation

14.4.3.3 Amputations

14.4.3.4 Shrapnel Injuries

References

Part III: Treatment of Orthopaedic Injuries: General Treatment Principles

15: Battlefield Triage

15.1 Introduction

15.2 History

15.3 Triage Context

15.4 French Army Triage System

15.4.1 Medical Evacuation (MEDEVAC) Categories

15.4.2 French Army Classification

15.5 Triage Systems (Categorisation and Assessment)

15.6 Issues

15.6.1 Logistic Problems

15.6.2 Triage Area

15.6.3 Identification and Registration

15.6.4 Medical Team

15.6.5 Evacuation

15.6.6 Triage Officer

15.7 Ethical Problems

15.7.1 Expectant Cases

15.7.2 Triage and Neutrality

References

16: Fluid Resuscitation in Mass Casualty Incident

16.1 Introduction

16.2 Triage

16.3 Prehospital Care

16.4 Hospital Care

16.5 Resuscitation

16.5.1 Introduction

16.5.2 Volume Resuscitation

16.5.2.1 Fluids Administration

16.5.2.2 Blood and Blood Products Administration

16.5.2.3 Coagulopathy of the Injured

16.5.2.4 Early Transfusion

16.5.2.5 Massive Transfusion (MT)

16.5.2.6 Multiple Transfusion Protocol (MTP)

16.5.2.7 Other Blood Products

Fibrinogen

Lyophilized Plasma

16.6 Imaging

16.6.1 Focused Assessment with Sonography in Trauma (FAST) in MCI

References

17: Transfusion Service and Blood Banking in Natural Disasters

17.1 Introduction

17.2 Guidelines for Blood Centers

17.3 Calculation of Blood Requirement

17.4 Historical Examples of Blood Use in Major Natural Disaster Events

17.4.1 Wenchuan County (Sichuan Province) Earthquake (May 2008)

17.4.2 Haiti Port-au-Prince Earthquake, January 2010

17.4.3 The Great East Japan Earthquake, March 2011

17.5 Coagulopathy of Massively Bleeding Patients

17.6 Blood Products for Bleeding Patients

References

18: Diagnostic Imaging in Mass Casualty Events

18.1 Introduction

18.2 Planning and Setup

18.3 Conventional Radiography

18.4 Ultrasound

18.5 Computed Tomography

18.6 Magnetic Resonance Imaging

18.7 Interventional Radiology

18.8 Blast Injuries

References

19: Mass Casualties and Damage Control Orthopedics

19.1 Introduction

19.2 Triage

19.3 Different Settings of Mass Casualty

19.3.1 Military Conflicts

19.3.2 Natural Disasters

19.3.3 Terrorist Attack

19.4 Injury Pattern

19.4.1 Compartment Syndrome

19.4.2 Crush Injuries and Syndrome

19.4.3 Blast Injury

19.4.4 Hypothermia

19.5 Damage Control Orthopedics (DCO) and Early Total Care (ETC)

19.6 Musculoskeletal Trauma: Amputation and Late Presentation

References

20: Prevention of Infection in Open Fractures in Mass Disasters

20.1 General Considerations

20.2 Epidemiology of Open Fractures in Mass Disasters

20.3 Open Fracture Management in Mass Disasters

20.3.1 Patient and Injury Assessment

20.3.2 Open Fracture Classification

20.3.3 Temporary Coverage and Immobilization of the Fractured Extremity

20.3.4 Antibiotic Administration and Tetanus Prophylaxis

20.3.4.1 Antibiotic Administration

20.3.4.2 Tetanus Prophylaxis

20.3.5 Wound Irrigation and Debridement

20.3.5.1 Irrigation

20.3.5.2 Debridement

20.3.6 Fracture Stabilization

20.3.7 Wound Management and Soft Tissue Coverage

20.3.8 Amputation

References

21: Primary Skeletal Stabilization and Role of External Fixations

21.1 Introduction

21.2 External Fixation

21.3 Advantages of External Fixation

21.4 Disadvantages of External Fixation

21.5 External Fixation Frames

21.5.1 Unilateral Tubular External Fixation

21.5.2 Trans-articular Bridging Frame

21.5.3 Circular, Ilizarov-Type Frame

21.5.4 Hybrid External Fixation

21.6 External Fixation Technique and Hardware

References

22: Crush Injury and Crush Syndrome in an Earthquake Disaster Zone

22.1 Understanding Crush Injury and Crush Syndrome

22.2 Pathophysiology

22.3 Diagnosis [9]

22.3.1 Management

22.3.1.1 General

22.3.1.2 Local

Open MMCI

Closed MMCI: Acute Mechanical Muscle-�Crush Compartment Syndrome

22.3.1.3 Special Aspects of Management in an Earthquake Disaster Zone

References

23: Wound Care: From Primary Debridement to Final Reconstruction

23.1 Extremity Evaluation

23.1.1 Anatomy

23.1.1.1 Upper Extremity

23.1.1.2 Lower Extremity

23.1.2 Wound Inventory

23.1.2.1 Contamination

23.2 Debridement

23.2.1 Primary Wound Debridement

23.2.1.1 Revascularization

23.2.1.2 Temporary Fixation

23.2.1.3 Wound Coverage and Dressing

23.2.1.4 Antibiotics

23.2.2 Secondary Wound Debridement

23.3 Reconstruction

23.3.1 The Reconstructive Ladder

23.3.1.1 Secondary Intention Closure

23.3.1.2 Direct Closure (Primary or Delayed Primary)

23.3.1.3 Skin Grafts

23.3.1.4 Local and Regional Flaps

23.3.1.5 Free-Tissue Transfer

23.3.2 Preoperative Preparation

23.3.3 Primary Reconstruction

23.3.3.1 Soft Tissue

23.3.4 Secondary Reconstruction

23.3.4.1 Bone Defects

23.3.4.2 Nerve Defects

References

24: Vascular Injuries and Replantation

24.1 Overview and Significance

24.2 Epidemiology, Consequences, and Pattern of Injuries

24.2.1 Epidemiology

24.2.2 Mortality and Amputation

24.2.3 Vascular Injury Pattern

24.2.4 Associated Tissue Injuries

24.3 Field Management of Arterial Ischemia and Hemorrhage

24.3.1 Field Management of Ischemia

24.3.2 Field Management of Hemorrhage

24.4 Diagnosis of Arterial Injury

24.4.1 History and Physical Examination

24.4.2 CT Angiography

24.4.3 Intraoperative Angiography

24.5 Extremity Arterial Anatomy and Exposures

24.5.1 Axillary Artery

24.5.2 Brachial Artery

24.5.3 Radial and Ulnar Arteries

24.5.4 Femoral Arteries in the Groin

24.5.5 Superficial Femoral Artery

24.5.6 Popliteal Artery

24.5.7 Tibial Arteries

24.6 Damage Control Vascular Surgery

24.6.1 Hemorrhage Associated with Pelvis Fractures

24.6.2 Non-reconstructive Management: Ligation

24.6.3 General Operative Principles and Techniques

24.6.4 Shunting

24.7 Physiologic Consequences of Ischemia and Reperfusion

24.8 Vascular Decision-Making in Traumatic Amputation and the Mangled Extremity

References

25: Blast and Fragment Injuries of the Musculoskeletal System

25.1 Introduction

25.2 Pathomechanics and Pathophysiology

25.2.1 Blast Physics

25.2.2 Blast Injury Classification

25.2.3 Mechanisms of Orthopedic Injury

25.3 Treatment Principles

25.3.1 Nonoperative Treatment

25.3.2 Antibiotic Prophylaxis

25.3.3 Treatment of Selected Small Fragment Wounds

25.3.4 Surgical Treatment

25.3.4.1 General Principles

25.3.4.2 Extremity Amputations

25.3.4.3 Dismounted Complex Blast Injuries

25.3.4.4 Junctional Injuries

25.3.5 Other Considerations

References

26: The Role of the Anesthesiologist in the Response to Mass Casualty Catastrophic Events

References

Part IV: Treatment of Orthopaedic Injuries: Specific Orthopaedic Injuries

27: Hand and Wrist Injuries

27.1 Introduction

27.2 In the Field of Mass Casualties

27.2.1 Emergency Evaluation

27.2.1.1 Vascular Status of the Involved Upper Limb

27.2.1.2 Neurological Status of the Involved Limb

27.2.1.3 Soft Tissue Examination

27.2.2 After Admission into Proper Set-Ups

27.3 Proper Planning

27.3.1 Timing of Surgical Treatment

27.3.2 Achievement Goal of Surgical Treatment

27.4 General Principles of Management

27.5 Hand Injuries with Fractures

27.5.1 Fracture of Distal Phalanx

27.5.2 Fracture of Middle and Proximal Phalanx

27.5.3 Fractures of Metacarpals

27.5.4 Soft Tissue Injuries

27.5.5 Conclusion

27.6 Wrist Injuries

27.6.1 Distal Radius Fracture

27.6.2 Carpal Injuries

27.6.3 Combined Radial Carpal Fractures

27.6.4 Fracture of the Distal Ulnar

27.6.5 Injury of the Distal Ulnar Wrist Complex

References

28: Management of Mangled Extremities

28.1 Introduction

28.2 Initial Evaluation

28.3 Examination

28.4 Radiographic Examination

28.5 Decision of Salvage

28.6 Debridement

28.7 Timing of Debridement

28.8 Technique of Debridement

28.8.1 Essentials

28.8.2 The Technique

28.8.3 Second Look after Debridement

28.9 Skeletal Management

28.9.1 Skeletal Stabilization

28.10 Primary Internal Fixation

28.11 Vascular Reconstruction

28.12 Bone Loss

28.13 Source of Infection in Open Injuries

28.14 Zone of Injury

28.15 Timing of Soft Tissue Reconstruction

28.15.1 Problem of Delay

28.16 Type of Soft Tissue Reconstruction

28.17 Vacuum-Assisted Closure Devices in Open Fractures

28.18 Ganga Hospital Protocol Based on GHOIS

28.19 Fix and Primary Closure

28.19.1 Fix and Delayed Closure

28.19.2 Fix and Skin Grafting

28.19.3 Fix and Early Flap

28.19.4 Fix and Delayed Flap

28.19.5 Staged Reconstructions

References

29: Limb Salvage: Lower Extremity

29.1 Introduction

29.2 Soft Tissue Injuries

29.2.1 Debridement and Irrigation

29.2.2 Vessel Injuries

29.2.3 Nerve Injuries

29.3 Fractures

29.3.1 External Fixation

29.3.1.1 External (Pin) Fixators

29.3.1.2 Ring Fixator (Wires)

29.3.1.3 Hybrid Fixator

29.3.1.4 Joint-Bridging External Fixation

29.3.2 Internal Stabilization

29.4 Wound Closure/Soft Tissue Closure

29.4.1 Vacuum-Assisted Closing (VAC)

29.4.2 Synthetic Skin Coverage

29.4.3 Skin Grafting

29.5 Complications

29.5.1 Infections

29.5.2 Compartment Syndrome

29.5.3 Crush Injury

29.6 Large Bone Defects

29.6.1 Wire and Bone Cement Constructs

29.6.2 Distraction Osteogenesis

29.6.3 Nailing After Lengthening

29.6.4 Bone Grafting

References

30: Foot and Ankle Trauma: From the Crush to the Missed and Neglected Injuries

30.1 Introduction

30.2 Epidemiology

30.3 Evaluation

30.4 Soft Tissue Management

30.4.1 General Principles

30.4.2 Compartment Syndrome

30.5 Fractures and Dislocations

30.5.1 Open Fractures

30.5.2 Ankle Fractures

30.5.3 Talus and Calcaneus Fractures

30.5.4 Midfoot Injuries

30.5.5 Multiple Metatarsal Fractures

30.6 Sequelae of Foot and Ankle Injuries

30.6.1 Distal Tibial Nonunion and Nonunion After Open Fracture

30.6.2 Chronic Osteomyelitis

30.6.3 Nerve and Vascular Injury and Residuals of Compartment Syndrome

30.6.4 Foot Deformity

30.6.5 Skin Coverage

30.6.6 Forefoot and Midfoot Injuries

30.6.6.1 Toe Injuries

30.6.6.2 Lesser Metatarsal Fractures

30.6.6.3 First Metatarsal Fractures

30.6.6.4 Partial Forefoot Amputation

30.6.6.5 Neglected Lisfranc Injuries

30.6.7 Navicular Fractures

30.6.8 Hindfoot Injuries

30.6.8.1 Late Problems After Calcaneal Fractures

30.6.8.2 Posttraumatic Talar Deformity and Talar Body AVN

30.7 Summary

References

31: Spine Injuries in Mass Casualties

31.1 Introduction

31.2 Earthquakes

31.3 Urban Terrorism

31.4 Special Injuries

31.5 Hurricanes

References

32: Pelvic and Acetabular Trauma

32.1 Introduction

32.1.1 Anatomy

32.2 Causes and Severity of Injury

32.2.1 Causes

32.2.1.1 Motor Vehicle Accident (MVA)

32.2.1.2 Fall from Great Height

32.2.1.3 Crush Injury

32.2.1.4 Burials

32.2.2 Severity

32.2.2.1 Hemodynamic Versus Biomechanical Stability

32.2.2.2 Triage

32.3 Classification

32.3.1 Pelvis

32.3.1.1 AO Classification

32.3.2 Acetabulum

32.3.2.1 Classification by Judet and Letournel

32.4 Diagnostics

32.4.1 Preclinical

32.4.2 Clinical

32.4.2.1 Associated Injuries

32.4.2.2 Ultrasound

32.4.2.3 X-Ray

Radiologic Anatomy of Pelvic X-Ray

32.4.2.4 CT

32.4.2.5 MRI

32.5 Therapy

32.5.1 Indication

32.5.2 Initial and Emergency Therapy

32.5.2.1 Compression

32.5.2.2 Internal Rotation

32.5.2.3 Circumferential Pelvic Antishock Sheet

32.5.2.4 Prehospital Volume Therapy

32.5.2.5 Pelvic C-Clamp

32.5.2.6 External Fixator

32.5.2.7 Pelvic Packing

32.5.2.8 Embolization

32.5.2.9 Collateral Injuries

32.5.2.10 Clotting Management

32.6 Case Reports

References

33: Amputations in Disasters

33.1 Introduction

33.2 History

33.3 General Principles

33.3.1 Introduction

33.3.2 Crush Injury

33.3.3 Blast Wound Amputation

33.4 Anesthesia

33.5 Indications for Amputations

33.5.1 Patient Related

33.5.2 Surgeon and Facility Related

33.6 Surgical Technique

33.6.1 General

33.6.2 Hemostasis

33.6.3 Secondary Examination

33.6.4 Wound Care

33.6.5 Level of Amputation

33.6.6 Soft Tissue Management

33.6.7 Arteries

33.6.8 Nerves and Tendons

33.6.9 Skin Management and Wound Closure

33.7 Upper Extremity Amputations

33.7.1 Finger and Ray Amputations

33.7.1.1 Fingertips

33.7.1.2 Digits

Index Finger

33.7.2 Wrist Disarticulation

33.7.3 Forearm Amputation

33.7.4 Transhumeral Amputation

33.8 Lower Extremity Amputations

33.8.1 Below-Knee Amputation

33.8.1.1 General Principles

33.8.1.2 Amputation Technique

33.8.1.3 Postoperative Management

33.8.2 Knee Disarticulation

33.8.3 Above-Knee (Transfemoral) Amputation

33.8.3.1 General

33.8.3.2 Level of Amputation

33.8.3.3 Amputation Technique [88]

33.8.4 Hip Disarticulation

33.9 Complications

33.9.1 Early Complications

33.9.1.1 Delayed Hemorrhage

33.9.1.2 Skin Flap Breakdown

33.9.1.3 Infection

33.9.2 Late Complications

33.9.2.1 Stump Instability

33.9.2.2 Ulceration

33.9.2.3 Neuroma

33.9.2.4 Heterotopic Ossification

33.9.2.5 Phantom Limb Pain

33.9.2.6 Contractures

References

34: Nonunion and Osteomyelitis Following Fractures

34.1 Introduction

34.2 Classification

34.2.1 Classification of Aseptic Nonunions

34.2.2 Classification of Chronic Osteomyelitis

34.3 Evaluation

34.3.1 Clinical Evaluation

34.3.2 Radiological Evaluation

34.3.3 Laboratory Studies

34.4 Treatment

34.4.1 Debridement for Infected Nonunion

34.4.2 Antibiotic Beads

34.4.3 The Existing Hardware

34.4.4 Soft Tissue Consideration

34.4.5 Hyperbaric Oxygen Treatment

34.4.6 External Fixation Modalities

34.4.6.1 Monofocal Distraction

34.4.6.2 Consecutive Monofocal Compression Distraction

34.4.6.3 Bifocal Strategy: Acute Shortening and Gradual Lengthening

34.4.6.4 Fibula Transport

34.4.7 Internal Fixation

34.4.7.1 Plate Osteosynthesis

34.4.7.2 Exchange Nailing

34.4.7.3 Titanium Cage and Grafting for Defect Nonunions

34.4.8 Combination Techniques

34.4.9 Biological Stimulation

34.4.9.1 Vascularized Bone Grafts

34.4.9.2 Central Bone Grafting for Tibial Nonunions

34.4.9.3 Electrical Stimulation

34.4.9.4 Partial Fibulectomy

34.4.9.5 Bone Marrow Injection

34.4.9.6 Platelet-Rich Plasma Injection

34.5 Future

References

Part V: Treatment of Orthopaedic Injuries: Pediatric Injuries

35: An Overview: Pediatric Trauma During Natural and Man-Made Disasters

35.1 Introduction

35.2 Specifics of Pediatric Medical Care

35.3 Epidemiology

35.4 Who Is Supposed to Provide Medical Assistance to Children in Earthquakes?

35.5 How Our Work Is Organized in Disaster Zones

References

36: Pediatric Trauma in Earthquakes: General Principles of Care in Pediatric Trauma During Earthq

36.1 Specifics of Treating Severe Traumatic Injuries in Children

36.2 Terminology and Consistency of Notions

36.3 Severity of Trauma and Gravity of Condition Evaluation

36.4 Trauma Disease

36.5 Severe Injury Outcomes Scale (OISS)

36.6 Associated Trauma

36.7 Prehospital Stage

36.8 Hospitalization into a Specialized Inpatient Facility

36.9 Diagnostics in Specialized Inpatient Facility

36.10 Surgical Treatment

References

37: Anesthesiology and Resuscitation in Children During Earthquakes

37.1 Introduction

37.2 The Requirements for Anesthesiologist-­Resuscitator that Is a Part of a Pediatric Mobile

37.3 In Case of Mass Influx of Injured Children, Anesthesiologist’s Work Has Certain Features

37.4 Distinctive Features of Anesthesiologist-­Resuscitator’s Work in the Mobile Pediatric Te

37.5 Solutions

37.6 Children’s Intake into Surgery, Premedication

37.7 Anesthesia Induction and Choice of Anesthesia at the Main Stage of the Surgery

37.8 Types of Anesthesia During the Main Stage of the Surgery

37.9 Anesthesiological Equipment and Consumable Supplies

References

38: Medical Care for Children with Skeletal Injuries After Earthquakes

38.1 Introduction

38.2 Epidemiology

38.3 Equipment

38.4 Errors in the Treatment of Skeletal Injuries in the Disaster Zone

38.5 Prehospital Stage

38.6 Hospital Stage

38.7 Complications

References

39: Crush Syndrome in Children

39.1 Epidemiology

39.2 Clinical Findings

39.3 Treatment

39.3.1 Conservative

39.3.1.1 Approaches to Bandaging

39.3.2 Surgical Treatment Methods

39.4 Amputation Indications

References

40: Amputations in Children with Severe Trauma

40.1 Introduction

40.2 Epidemiology

40.3 Causes of Amputation

40.4 Amputational Strategy

40.5 Methods for Amputation for Children

40.6 Stages of Surgical Treatment

40.7 Postsurgical Treatment

40.8 Reamptutation of Residual Limbs

References

41: Spine Trauma in Children in Earthquakes

41.1 Introduction

41.2 Epidemiology

41.3 Classification, Basic Mechanisms, and  Pathogenesis of Spine and Spinal Cord Trauma in Chi

41.4 Primary Evaluation of Patients’ Condition, Triage, and Providing Help for Spinal Trauma o

41.5 Our Observations

References

42: Severe Fractures and Pediatric Orthopedic Trauma in Disasters and Mass Casualties

42.1 General Concepts in Pediatric Orthopedic Trauma and Polytrauma

42.1.1 Medical Concepts

42.1.2 Head and Neck Injuries

42.1.3 Visceral Injuries

42.1.3.1 Intra-abdominal Injuries

42.1.3.2 Thoracic Injuries

42.1.3.3 Genitourinary Injuries

42.1.4 Musculoskeletal Injuries

42.1.4.1 Musculoskeletal General Considerations in Pediatrics

42.1.4.2 Compartment Syndrome

42.1.4.3 Open Fractures

42.1.4.4 Peripheral Nerve Injuries

42.2 Issues Specific to Disaster Pediatric Orthopedic Trauma

42.2.1 General Issues

42.2.2 Initial Response

42.2.3 Recommended Trauma Equipment for Pediatrics

42.2.4 Injuries Specific to Disasters

42.2.4.1 Burns and Smoke Inhalation

42.2.4.2 Electrical Injury

42.2.4.3 Blast Injuries

42.3 Specific Pediatric Orthopedic Injuries

42.3.1 General Concepts in Pediatric Polytrauma Orthopedic Treatment

42.3.2 Shoulder and Clavicle Injuries

42.3.2.1 Medial Clavicle Physeal Separation

42.3.2.2 Clavicle Shaft Fractures

42.3.2.3 Proximal Humerus Fractures and Dislocations

42.3.2.4 Humeral Shaft Fractures

42.3.2.5 Fractures About the Elbow

42.3.2.6 Forearm and Distal Radius Fractures

42.3.2.7 Fractures of the Hand and Carpus

42.3.2.8 Spine Fractures

42.3.2.9 Fractures of the Pelvis and Acetabulum

42.3.2.10 Femur Fractures

42.3.2.11 Proximal Tibia Fractures

42.3.2.12 Tibial Shaft Fractures

42.3.2.13 Ankle Fractures

42.3.2.14 Foot Fractures

42.3.2.15 Traumatic Amputations

42.4 Recent Experience in Pediatric Trauma in Disasters and MCE

42.4.1 2011 Japanese Tsunami [37]

42.4.2 2010 Haiti Earthquake

42.4.3 Other Recent Disasters

References

Part VI: Treatment of Orthopaedic Injuries: Continuation of Care

43: Prosthetic Rehabilitation in Disaster Areas

43.1 Prosthetic Rehabilitation in Disaster Areas

43.2 Number of Amputees and Amputations

43.3 Amputation Levels

43.4 Stump Shapes

43.5 Local Prosthetic Technological Knowledge

43.6 Follow-Up Capabilities

43.7 Special Populations

43.7.1 Children

43.8 National Financial Resources

43.9 Local Priorities

43.10 Upper Limb vs. Lower Limb

43.11 What Kind of Artificial Limb Should Be Provided in These Situations?

43.12 Conclusions and Recommendations

References

44: Education and Training in War Surgery and Disaster Management

44.1 Introduction

44.2 The Evolution of War Surgery and Training

44.3 Training for Work in the Humanitarian Sector

44.4 Professionalization of the Humanitarian Sector

44.5 Orthopedic Surgery Training in Disaster Preparedness and Management

References

45: Terminology and Resources for Disaster Orthopedics

45.1 Introduction

45.2 Terminology: Mass Casualty Incident Hospital Planning

45.3 International Orthopedic Organizations and Resources

45.3.1 International Society of Orthopaedic Surgery and Traumatology (SICOT)

45.3.2 AO Foundation

45.3.3 Canadian Orthopaedic Trauma Society

45.3.4 International Conference on Preparedness and Response to Emergencies and Disasters (IPRED

45.3.5 Italian Society of Orthopaedics and Traumatology (SIOT)

45.3.6 World Orthopaedic Concern (WOC)

45.3.7 Johanniter International (JOIN)

45.3.8 Extended Listing of Orthopedic-Related Organizations

45.4 Resources for Disaster Preparedness

45.4.1 National Disaster Medical System

45.4.1.1 Disaster Medical Assistance Team (DMAT)

45.4.1.2 International Medical Surgical Response Team (IMSURT)

45.4.2 Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP)

45.4.3 Medical Reserve Corps (MRC)

45.4.4 US Public Health Service Commissioned Corps

45.4.5 American Nurses Association (ANA)

45.4.6 Orthopaedic Trauma Association (OTA)

45.4.7 American Association of Orthopedic Surgeons (AAOS)

45.4.8 Federal Emergency Management Agency (FEMA) Disaster Training Modules

45.4.9 Association of American Medical Colleges (AAMC)

45.5 Other Resources

45.5.1 Government and State Resources

45.5.2 Medical Decision Making

45.5.3 Terrorism and Bioterrorism

45.5.4 Pandemics and Outbreaks

45.5.5 Natural Disasters

45.5.6 Radiational Disasters

45.5.7 Triage

45.5.8 Pediatric Disasters

45.5.9 Mass Casualties Response and Disaster Preparedness

45.5.10 Personal Protective Equipment

45.5.11 Medical Devices and Equipment

45.5.12 Disaster Communication and Information Technology

45.5.13 Transport, Mobile Care and Telemedicine

45.5.14 Ethical Issues of Disaster

45.5.15 Public Health Aspects

45.5.16 Role of Orthopedic Surgeons in Global Relief

45.5.17 Statistics and Systematic Reviews

Erratum to: Chapters 10 and 21 of Orthopedics in Disasters

Index

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