Trauma by Court-Brown, Charles; McQueen, Margaret M.; Tornetta, Paul

By Court-Brown, Charles; McQueen, Margaret M.; Tornetta, Paul

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Clearly the prognosis for different nerve lesions varies, and Box 5-2 lists the factors associated with a poorer prognosis after gunshot injuries. Proximal nerve lesions resolve more slowly than distal lesions, and multiple or dense nerve lesions have a poorer prognosis than isolated lesions. Nerve repair is successful in about 25% of neurotmeses. qxd 8/5/05 11:37 AM Page 29 Chapter 5 / Gunshot Injuries number of issues that are debated by orthopaedic surgeons, however. BOX 5-2 FACTORS ASSOCIATED WITH A WORSE PROGNOSIS AFTER NERVE DAMAGE Debridement of Low-Energy Wounds Neurotmesis Proximal nerve damage Multiple nerve lesions Reflex sympathetic dystrophy ■ Unlike low-energy wounds caused by blunt trauma, most low-energy gunshot wounds can be safely treated with simple local wound care with superficial irrigation (Fig.

Incidence of adult respiratory distress syndrome in patients with multiple musculoskeletal injuries; effect of early operative stabilization of fractures. J Trauma 1985;25:375–384. Pape HC, Giannoudis P, Krettek C. The timing of fracture treatment in polytrauma patients: relevance of damage control orthopedic surgery. Am J Surg 2002;183:622–629. Pape HC, Grimme K, van Grievesen M, et al. Impact of intramedullary instrumentation versus damage control for femoral fractures on immunoinflammatory parameters: Prospective randomized analysis by the EPOFF study group.

The cosmetic effect is generally better than with a fasciocutaneous flap (see Fig. 4-5). Soft Tissue Cover ■ Most open wounds do not require plastic surgery. ■ Increasingly, however, plastic surgery techniques are being used in open fractures. 0 — — — — — — — — — — SUGGESTED READING Court-Brown CM, McQueen MM, Quaba AA, eds. Management of open fractures. London: Martin Dunitz, 1996. Court-Brown CM, Rimmer S, Prakash U, et al. The epidemiology of open long bone fractures. Injury 1998;29:529–534.

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