Orthopedic management of children with multiple injuries.

Trauma in children is a serious problem that has a major medical, social, and financial impact on the society. More than 10,000 children die in the United States each year from serious injury ( 50% of all deaths in children). Nearly one in every six children ( 10 million children) visit the emergency department each year in the United States because of trauma. Boys are injured twice as often as girls.1–3 When children suffer a severe trauma, they usually sustain abdominal, head, and chest injuries, which can be potential life-threatening injuries. In the same time, most children with multiple injuries will sustain extremity injuries and fractures. Orthopedic injuries are rarely life threatening; however, they are commonly encountered in children with multiple injuries and can be a cause for long-term morbidity.4 The treatment of children with multiple injuries should follow the principles of the Advanced Life Trauma Support, and orthopedic care must never precede the treatment of more serious life-threatening injuries.3 It should be noted that children with multiple injuries have better survival than adults.5,6 The orthopedic injuries, despite that they are rarely fatal, can still be a reason for long-term morbidity and disability.4,5,7 Optimal orthopedic management should be provided to children with multiple injuries keeping in mind that their recovery is possible even in the most severely affected cases. Presence of skeletal injuries worsens the prognosis of the children with multiple injuries. The pediatric trauma score has a close relation to survival. It consists of six parameters. One of these elements is presence of skeletal injuries.8 According to this score, the presence of multiple fractures or open fracture carries a worse prognosis than presence of a single closed fracture. This article will focus on the musculoskeletal management of the multiple injuries in pediatric population. It will give an overview to both orthopedic and nonorthopedic trauma surgeons regarding the important facts related to the orthopedic aspects of the management of children with multiple injuries. Initial management of extremity injuries should include the following:3