Concept and causes of development
Historically, attempts were made to divide the response to severe injury into separate isolated syndromes: pain shock, blood loss, thromboembolism, or protein-electrolyte imbalance. Today it has been proven that this approach is ineffective. All emerging changes constitute a single traumatic disease.
The basis of its pathogenesis is the interplay of two factors:
- Adaptive reactions (aimed at survival and restoration of tissue structure).
- Pathological processes (hypovolemia, traumatic toxicosis, organ dysfunction).
It is important to understand that not every injury triggers this disease. Isolated fractures or minor soft tissue wounds may proceed exclusively as a local process. The development of a systemic reaction depends on the severity of injuries, baseline body reserves, and the timeliness of medical care provided.
Acute period
Lasts up to 3 days. The main characteristic of this stage is the development of shock, primary organ damage, and the subsequent struggle to stabilize vital functions. The patient continuously requires intensive care measures. Three phases are distinguished:
- Instability of vital functions: coincides in time with shock, requiring emergency correction of life-threatening conditions.
- Relative stabilization: adaptation is unstable, and a huge risk of decompensation persists. Reserves are depleted, creating a breeding ground for early infectious complications. Intensive therapy continues.
- Stable stabilization: the body begins to independently maintain life. Prevention of infections comes to the forefront.
In some cases, homeostasis stabilization occurs at an extremely low level of viability—a persistent pathological state forms.
Period of full-blown clinical picture
Occurs if the patient survived shock with adequate treatment. Due to colossal energy expenditures in the first stage, a pronounced oxygen debt arises, and detoxification and immune defense mechanisms fail. Multiorgan pathology forms. The period proceeds in two phases:
- Catabolic (up to 7 days). Lysis of necrotic tissues occurs. Intoxication increases, and the risk of thrombosis, embolism, and purulent processes is high. The severity of the condition depends both on the injury itself and on the systemic response.
- Anabolic (from weeks to months). Proliferative processes begin—tissues granulate, epithelialize, and scar. However, dystrophic changes occur in internal organs. This is precisely where the main causes of mortality lie: sepsis, pneumonia, renal and hepatic failure, fat embolism, bedsores, and edema (brain or lungs).
Rehabilitation and additional classifications
The rehabilitation period can last for years. Its goal is adaptation to the consequences of injury, physical, social, and psychological recovery. Doctors combat muscle atrophy, contractures, and chronic organ failure.
In addition to temporal stages, traumatic disease is classified according to:
- Presence of complications (complicated and uncomplicated).
- Nature of injuries (isolated, multiple, polysystem, combined).
- Dominant focus (traumatic brain injury, chest, abdominal, or musculoskeletal trauma).
Severity grades are also distinguished. In grade I, the acute period is mild, and the prognosis is favorable. In grade II, compensated shock and 1–2 complications (predominantly infectious) are observed, and the prognosis is also usually favorable.
Local treatment of fractures and complications
Parallel to general detoxification therapy, local work is carried out. Actions performed in the acute period can be corrected after 7–10 days (only upon normalization of metabolism and general condition).
- With primary wound healing: the goal is stable fixation. Massive internal fixators are permitted to be placed no earlier than 3 weeks after injury. Conservative treatment is permissible.
- With an unhealed wound: external fixation devices remain the method of choice (hinged structures are used for joints).
- Scar tissue problem: a coarse rigid scar deprives the bone of adequate blood supply, blocking fracture consolidation. Such tissue frequently ulcerates and becomes inflamed. This problem is treated radically—by the method of pedicle skin grafting.
Briefly: answers to topical questions
What periods are distinguished in the course of traumatic disease?
Three main periods are distinguished in the course of traumatic disease.
- Acute period — lasts up to 3 days, associated with the development of shock and stabilization of vital functions. Includes phases of instability, relative and stable stabilization.
- Period of full-blown clinical picture — characterized by multiorgan pathology. Divided into catabolic (lysis of necrotic tissues) and anabolic (proliferative processes) phases.
- Rehabilitation period — lasts up to many years, aimed at physical, psychological, and social recovery, as well as adaptation to the consequences of injury.
What degrees of severity of traumatic disease are distinguished in the modern classification?
The modern classification distinguishes three degrees of severity of traumatic disease.
- Grade I — the acute period is mildly expressed, complications are rare, and the prognosis is favorable.
- Grade II — accompanied by compensated shock in the acute period and the development of 1–2 complications (predominantly infectious) in the period of the full-blown clinical picture. The prognosis is usually favorable.
- Grade III — characterized by decompensated shock, the development of more than two complications, the predominance of general disorders and multiple organ failure. The prognosis is mostly unfavorable.
What scales and laboratory markers are used to assess the severity of traumatic disease?
To assess the severity of traumatic disease and prognosis, the TS scale (Trauma Score) is used.
- The TS scale is based on the combined assessment of hemodynamics, respiration, and the patient's reaction on the Glasgow Coma Scale.
- The total sum of codes is calculated using the formula: TS = A + B + C + D + E.
- The maximum possible sum is 16 points.
- The sources also provide an estimation of survival probability depending on the sum of TS points.
Laboratory markers specific for assessing the severity of traumatic disease are not described in the cited sources.
Class and exam questions
Does any trauma cause traumatic disease?
No, uncomplicated soft tissue injuries and isolated fractures can proceed exclusively as a local process, without a systemic response of the entire body.
Why does multiple organ pathology occur in the post-traumatic period?
Against the background of survived shock, the body spends a colossal amount of energy. Oxygen debt arises, detoxification and immune defense mechanisms are depleted, leading to the disintegration of life support systems.
What is the danger of coarse scarring in the fracture zone?
Rigid scar tissue is poorly vascularized, which disrupts the bone consolidation process, provokes ulceration, and increases the risk of recurrent inflammation. Pedicle skin grafting is used to solve the problem.
What else to study on this topic
- Pathophysiology of the development of hypovolemic shock in the acute period.
- Mechanisms of tissue oxygen debt formation.
- Principles of selection and application of hinged external fixation devices.
- Diagnostic criteria for compensated shock in grade II severity.
- Features of the course of traumatic disease with dominant traumatic brain injury.
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