General classification and conditions of occurrence
Injuries are systematized according to the conditions under which they were sustained by the patient:
- Occupational: divided into industrial and agricultural.
- Non-occupational: include domestic, street, transport, sports, pediatric, and intentional injuries.
- Military: gunshot wounds and closed injuries.
By the type of damaging factor (agent), injuries are classified into mechanical, thermal, chemical, radiation, gunshot, and combined. According to the duration of exposure, they can be acute (sudden single exposure) and chronic (the result of prolonged repeated exposure, e.g., Dupuytren's contracture or calluses).
Mechanical injuries and relation to cavities
Depending on the preservation of the integrity of integuments, mechanical injuries are divided into:
- Closed: the skin and mucous membranes retain their integrity. It is important to remember that due to the high anatomical stability and elasticity of the skin, severe tissue crushing, closed fractures, or ruptures of internal organs may be concealed beneath it.
- Open: accompanied by damage to the skin or mucous membranes, which creates a gateway for infection.
In relation to natural body cavities (skull, chest, abdominal cavity, joints):
- Penetrating: the damage breaches the airtightness of the cavity. This poses a direct threat to life due to the risk of hemorrhage, peritonitis, pneumothorax, and infection.
- Non-penetrating: the airtightness of the cavities is preserved.
According to the mechanism of occurrence, there are direct injuries (damage occurs directly at the site of force application, e.g., fracture of foot bones from falling a heavy load) and indirect injuries (occur at a distance from the impact site, e.g., spinal fracture when falling on the ischial tuberosities).
Nature of injuries and development of complications
Injuries can be simple, when only one organ or its part is affected (e.g., isolated femoral fracture), and combined, involving different localizations and the impact of multiple traumatic agents (femoral fracture combined with frostbite of the feet).
Based on the presence of complications, injuries are divided into uncomplicated and complicated. The development of complications is strictly distributed over time:
- Immediate: occur at the moment of injury or within the first hours (traumatic shock, acute blood loss, direct damage to vital organs).
- Early (intermediate): appear within a period ranging from several hours to weeks. The main cause is surgical infection. It can be local purulent (wound suppuration, peritonitis, pleurisy) or general purulent (sepsis, gas gangrene, tetanus).
- Late: occur at remote periods and are associated with chronic purulent infection (chronic osteomyelitis, fistula formation).
Factors determining injury severity
The degree of tissue destruction is influenced not only by the external impact but also by the patient's current internal state:
- Characteristics of the agent: heavy and hard objects cause more extensive destruction. Blunt objects more frequently lead to closed injuries, sharp ones to open injuries. The physics of the impact is of great importance: the direction of force, angle of action, and velocity determine the type of bone fracture (oblique, transverse, spiral).
- Anatomical and physiological features: parenchymal organs (brain, liver, spleen) are easily damaged even under minor force. Bone tissue, by contrast, exhibits significant resistance. The physiological state of the organ is critical: a filled hollow organ (e.g., stomach) sustains an extensive rupture upon impact or gunshot wound, whereas damage to an empty organ is limited to entry and exit wounds.
- Pathological changes: reduce tissue resistance. A spleen altered by malaria can rupture simply from turning over in bed. Tumors or osteomyelitis lead to pathological fractures under minor load. The risk is increased by nutritional disorders, anemia, and avitaminosis. In elderly individuals, age-related bone fragility also leads to severe injuries with minimal trauma.
- Adverse external environment: cold frequently leads to severe shock, and the combination of hypothermia with a fracture increases the risk of pneumonia and endarteritis. Heat and heavy contamination multiply the danger of infection.
Briefly: answers to topical questions
How are bone fractures classified according to the fracture line direction?
According to the direction and pattern of the fracture line, fractures are classified into several types.
| Type of fracture | Characteristics of the fracture line | Typical injury mechanism |
|---|---|---|
| Transverse | Straight line perpendicular to the bone axis | Direct impact |
| Oblique | Line at an angle to the bone axis | Bending |
| Spiral (torsion) | Line running in a spiral | Torsion of the limb |
| Impacted | One bone fragment enters another | Axial compression |
| Avulsion fracture | Detachment of a bone fragment | Sharp muscle contraction or ligament tension |
| Comminuted | Formation of multiple fragments (shards) | Fragmentation, high-energy trauma |
What phases of traumatic shock are distinguished in surgery?
In traumatic shock, two main phases of the clinical course are distinguished.
- Erectile phase (compensation stage) — very short, occurs immediately after the injury. Caused by the activation of the sympathoadrenal system. Characterized by psychomotor agitation, pallor of the skin and mucous membranes, mydriasis, elevated blood pressure, tachycardia, and tachypnea.
- Torpid phase (decompression stage) — characterized by exhaustion and failure of the body's adaptive reactions. Accompanied by general lethargy of the patient.
What types of wounds are distinguished depending on the nature of the wounding weapon?
Depending on the nature of the injury and the wounding projectile, the following types of wounds are distinguished:
- Incised wounds (vulnus incisum)
- Puncture wounds (vulnus punctum)
- Chopped wounds (vulnus caesum)
- Contused wounds (vulnus contusum)
- Crushed wounds (vulnus conguassatum)
- Lacerated wounds (vulnus laceratum)
- Bite (vulnus morsum)
- Gunshot (vulnus sclopetarium)
- Poisoned (vulnus venenatum)
- Mixed (vulnus mixtum)
What are the grades of severity of acute blood loss in trauma?
Depending on the volume of blood lost and the decrease in circulating blood volume (CBV), 4 degrees of severity of blood loss are distinguished:
- Grade I (mild) — loss of 500–700 ml of blood, CBV decrease by 10–15%.
- Grade II (moderate) — loss of 1000–1500 ml of blood, CBV decrease by 15–20%.
- Grade III (severe) — loss of 1500–2000 ml of blood, CBV decrease by 20–30%.
- Grade IV (massive) — loss of more than 2000 ml of blood, CBV decrease of more than 30%.
Class and exam questions
What is the difference between an open and a penetrating injury?
An open injury implies any damage to the skin or mucous membranes. A penetrating injury is damage that necessarily compromises the seal of an internal body cavity (joint, abdominal, or thoracic cavity, skull).
Why is it important to know if the stomach was full in blunt abdominal trauma?
The physiological state of the organ determines the severity of destruction. An impact on a full hollow organ causes extensive tissue rupture, whereas damage to an empty organ will be less extensive and limited to the direct impact zone.
What is an indirect mechanism of trauma?
This is a situation where the injury occurs at a distance from the direct point of force application. A classic example is a distal radius fracture (at a typical site) from falling on an outstretched hand, or a spinal fracture from falling on the buttocks.
What else to study on this topic
- Organization of trauma care at evacuation stages
- Types of local and general purulent surgical infections in trauma
- Pathophysiology of traumatic shock and the effects of hypothermia
- Biomechanics of fractures: oblique, transverse, and spiral bone injuries
- Characteristics of parenchymal organ injuries
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