Trauma Management

Preoperative Preparation

The trauma theater should be large enough for imaging equipment and traction table, with a temperature of 20–23°C and humidity at 50–60% to prevent hypothermia, as recommended by the American Society of Anesthesiologists 1
Ensure availability of appropriate implants and instruments, and a minimum theater team consisting of an operating department practitioner, two scrub practitioners, and a circulator, as recommended by the American Society of Anesthesiologists 1
Implement multimodal analgesia immediately, including regular paracetamol/acetaminophen, cautious use of opioids, and consideration of regional nerve block, as recommended by the American Heart Association and the American Society of Anesthesiologists 2, 1
Assess for pain and manage it promptly, and immobilize the affected limb to prevent further injury and promote patient comfort, as recommended by the American Society of Anesthesiologists 1
Provide IV fluid therapy and warming strategies as needed, and consider initial wound care and IV antibiotics for open fractures, as recommended by the American Heart Association and the American Society of Anesthesiologists 2, 1

Initial radiographs should include anteroposterior and lateral views, patellofemoral view to assess patellar alignment and fracture, and cross-table lateral view to visualize lipohemarthrosis, as recommended by the American College of Radiology 3
Consider advanced imaging, including MRI to fully assess soft tissue injuries and confirm extent of bone contusions, and CT to better characterize the depressed lateral femoral condyle fracture, as recommended by the American College of Radiology 3
Assess for vascular compromise, such as blue, purple, or pale extremities, which require immediate attention, as recommended by the American Heart Association 2

For a slight depressed fracture without intra-articular extension, non-operative management is appropriate if alignment is acceptable, with temporary immobilization followed by early protected mobilization 4
If the fracture is unstable or significantly depressed, consider delayed definitive osteosynthesis after initial stabilization, with timing based on patient's overall clinical status and resolution of swelling 4
Perform surgical management within 24 hours of admission if the patient is medically stable, and within 24-48 hours of admission to reduce mortality and complications, as recommended by the American Academy of Orthopaedic Surgeons 5, 6, 1
Treatment should be based on fracture type, including:
Consider tranexamic acid to reduce blood loss and transfusion needs, as recommended by the American Academy of Orthopaedic Surgeons 6

Both regional and general anesthesia are appropriate options, as stated by the American Society of Anesthesiologists 1
Regional anesthesia requires blockade of multiple nerves, and neuraxial blockade is effective for conscious patients, as recommended by the American Society of Anesthesiologists 1
General anesthesia requires additional postoperative analgesia, often via peripheral nerve blockade, as recommended by the American Society of Anesthesiologists 1
Administer prophylactic antibiotics within one hour of skin incision, implement active warming strategies, and consider additional monitoring for high-risk patients, including invasive blood pressure monitoring and cardiac output monitoring, as recommended by the American Society of Anesthesiologists 1

Protected weight-bearing as tolerated with immobilization, gentle isometric quadriceps exercises, and elevation and ice to control swelling, with progression to full weight-bearing, advance strengthening exercises, and gradual return to activities based on functional progress 4
Postoperative care should include continuation of analgesia protocol, monitoring for and treating anemia, implementing thromboprophylaxis for 4 weeks, and beginning early mobilization and weight-bearing as tolerated, as recommended by the American Academy of Orthopaedic Surgeons 1, 6
Allow weight-bearing as tolerated after surgical fixation in most cases, to promote patient mobility and reduce the risk of complications, as recommended by the American Academy of Orthopaedic Surgeons 6

Implement orthogeriatric comanagement to improve outcomes and reduce mortality, as recommended by the American Academy of Orthopaedic Surgeons and the European League Against Rheumatism 5, 6
Perform comprehensive geriatric assessment including cognitive evaluation, to identify potential comorbidities and promote patient-centered care, as recommended by the American Academy of Orthopaedic Surgeons 5
Consider osteoporosis evaluation and treatment, to reduce the risk of future fractures and promote bone health, as recommended by the American Academy of Orthopaedic Surgeons 6
Provide clear instructions on weight-bearing status, follow-up, and warning signs, to promote patient understanding and adherence to treatment plans, and consider early mobilization and rehabilitation programs, as recommended by the American Academy of Orthopaedic Surgeons 5