Traumatology

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Traumatology

 

literally, the study, prevention, and treatment of injuries to the organs and tissues. In the broad sense of the term, traumatology deals with many questions that are the subject matter of one or another surgical discipline (for example, neurosurgery or thoracic surgery), depending on the locus of injury. In the narrower sense, the term is traditionally applied to that division of clinical medicine that deals with injuries to the musculoskeletal system (bones, joints, muscles, ligaments, and tendons) and the skin. In the USSR and certain other countries, traumatology is combined with orthopedics (on the basis of their common anatomical substrate), forming an independent clinical discipline—as reflected in departmental titles and in the designations of scientific research institutes, scientific societies, and journals.

Traumatology, the oldest division of medicine, was the precursor of surgery. Traces of spliced fractures and of cranial bone operations have been found in ancient Egyptian mummies and Roman soldiers’ remains. Instruments are known to have been used in ancient times for operating on external injuries. From its very beginnings, traumatology included both preservative and operative treatment methods.

The basic principles of traumatology were first presented in the works of Hippocrates. Others who made significant contributions to this science were Avicenna, A. Paré, G. Dupuytren, E. O. Mukhin, N. I. Pirogov, A. A. Bobrov, E. T. Kocher, and the French surgeon J. F. Malgaigne (1806–65). Some important developments in traumatology included plaster casts, skeletal traction, and osteosynthesis. War-related “trauma epidemics” are often followed by rapid advances in traumatology and the adoption of new treatment methods.

Early in the 20th century, traumatology emerged as an independent division in the science and practice of surgery; it has grown in importance as a consequence of the rise in urbanization and industrialization, the growth of mass transportation, and the technological advances in living conditions. All these factors have contributed to the increasing number of fatal and crippling injuries from industrial, highway, and home accidents. Among the surgeons who played an important part in the development of traumatology were the German M. Kirschner, the Italian V. Putti, the Austrian L. Böhler, and the Englishman R. Watson-Jones. The founders of the Soviet school of traumatology were G. I. Turner, R. R. Vreden, N. N. Priorov, K. F. Vegner, M. I. Sitenko, V. V. Gorinevskaia, M. O. Fridland, and V. D. Chaklin.

The basic concerns of traumatology today are the study of pathogenetic changes in injured tissues and organs, the improvement of preservative and surgical means of treatment, and the prevention of posttraumatic complications. The prevailing type of treatment is conservative—for example, the single-stage repositioning of fractures, the alignment of bone segments, and the application of immobilizing splints or plaster casts. In the category of surgical intervention, a conservative treatment method that is widely used is that of gradual repositioning by means of skeletal traction or special repositioning devices. Surgical treatment methods have gained greater favor through the development and use of various metallic and plastic devices for osteosyn-thesis.

In most countries, including the USSR, injuries are treated by physicians who specialize in traumatology and orthopedics. Special centers for treating severe and complex traumas were first established in the 1960’s. In the USSR, injuries are treated in the special trauma units and consulting rooms of outpatient polyclinics. Inpatient care is provided in the trauma units or traumatology and orthopedics departments of large hospitals as well as in the surgical departments of rural hospitals. In the medical institutes of higher education, traumatology is taught in the departments of traumatology, orthopedics, and military surgery. (See alsoORTHOPEDICS for information on scientific centers, societies, and periodicals.)

REFERENCES

Polenov, A. L. Lechenie i dolechivanie povrezhdenii voennogo i mirnogo vremeni s tochki zreniia sovremennoi travmatologii. Petrograd, 1919.
Gorinevskaia, V. V. “Kratkii ocherk razvitiia travmatologii i voenno-polevoi khirurgii v Sovetskom Soiuze.” In Osnovy travmatologii, 3rd ed., vol. 1. Moscow, 1952.
Mnogotomnoe rukovodstvo po ortopedii i travmatologii, vol. 3. Moscow, 1968.
Watson-Jones, R. Perelomy kostei i povrezhdeniia sustavov. Moscow, 1972. (Translated from English.)

M. V. VOLKOV and V. IU. GOLIAKHOVSKII

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Total-body DR gives radiologists and traumatologists a complete picture of a patient's injuries rapidly and with minimal interference with critical patient stabilization efforts.
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This fracture poses challenges for the orthopaedic traumatologist as it is prone to complications due to distal part of tibia is weight bearing, inherent instability, bone being subcutaneous in whole extent with minimal soft tissue cover, poor blood supply, frequently being comminuted and compound.