Musculoskeletal trauma.

This article, written for emergency room physicians, provides simple, practical guidelines for the assessment and immediate treatment of musculoskeletal injuries of the multiply injured patient. The importance of the team approach and multidisciplinary management is stressed. An algorithm is provided to aid the emergency physician in performing the initial assessment and treatment in an organized fashion, with proper priorities given to musculoskeletal injuries. A systematic, anatomically oriented head-to-toe examination is suggested, performed in a cyclic fashion, correcting serious life- or limb-threatening pathology first. During the examination, special attention is required to support the cervical spine until there is radiologic evidence that the spine is stable. The emergency physician should remember that injuries that are not obvious during initial assessment may easily be missed unless the patient is re-examined in detail when the vital signs are stabilized. This is especially true in an unconscious patient with head or pelvic injuries or compartment syndromes. Guidelines are given for emergency treatment of dislocations, open fractures, and wounds because these may be the responsibility of the emergency room physician, depending upon local policies, availability of specialty staff, or constraints of time.