Trauma

Trauma is a physical injury caused abruptly to any part of the body by an external force. Its severity varies, ranging from minor cuts to severe internal organ damage.

There are different types of trauma depending on the type of injury sustained:

• Closed trauma: caused by a blow or strong impact, without skin disruption or penetration into the body.
• Open trauma: the object causing the trauma penetrates the skin and disrupts tissues, creating communication between a body cavity and the external environment. Internal organs may be exposed, and hemorrhage occurs, requiring urgent medical intervention.

Trauma is also classified according to the affected anatomical region:

• Extremity trauma: damage to bones, muscles, tendons, or ligaments.
• Contusions: a type of closed trauma affecting soft tissues or bones.
• Abrasions: loss of the superficial layer of the skin without involvement of deeper layers.
• Wounds: skin disruption with bleeding and possible underlying organ damage.
• Incised wound: clean cut with well-defined edges caused by a sharp object.
• Puncture wound: deep and narrow injury caused by a sharp, pointed object.
• Lacerated wound: caused by blunt impact from a non-sharp object.
• Sprains: joint injury due to ligament stretching or tearing, usually resulting from forced movement.
• Dislocations: abnormal displacement of bones within a joint.
• Fractures: cracks or complete breaks in a bone. When the fracture penetrates the skin, it is termed an open fracture.
• Muscle contractures: sustained, involuntary contraction of muscle fibers.
• Thoracic trauma: may involve bones (ribs, sternum, vertebrae) or internal organs (lungs, diaphragm, heart, blood vessels). Severe cases are life-threatening.
• Blunt thoracic trauma: caused by impacts, falls, or transportation-related accidents.
• Penetrating thoracic trauma: caused by sharp objects, firearms, or any object capable of perforating the skin and entering the body.
• Abdominal trauma: injury at the level of the abdominal wall with risk of damage to intra-abdominal viscera (stomach, liver, pancreas, spleen, gallbladder, intestines, kidneys, adrenal glands).
• Traumatic brain injury (TBI): often severe and requiring immediate specialist evaluation due to potential impairment of cerebral function.
• Spinal trauma: damage to vertebrae, ligaments, or the spinal cord. It is a medical emergency requiring immediate immobilization to prevent severe neurological injury.
• Dental trauma: one of the most common forms. It may result in minor lip injuries, mandibular fractures, or tooth fracture and avulsion.

Trauma may be mild or severe depending on the mechanism and anatomical site involved. In suspected spinal or brain injury, the following measures are recommended:

• Call emergency services immediately (112).
• Do not move the injured person, including removal of clothing or helmet. Rings, bracelets, and watches may be removed if feasible to prevent complications from swelling.
• Immobilize fractured extremities.
• In open wounds, cover with clean materials and apply compression to control bleeding.
• Keep the patient awake if possible, reassuring and speaking to them.
• Do not provide food or drink.
• Do not administer medications.

Symptoms

Clinical manifestations vary according to the type of trauma:

• Extremity and skin trauma:
• Contusions: swelling, pain, warmth, ecchymosis.
• Abrasions: burning sensation, erythema, mild swelling, blisters, slight bleeding.
• Wounds: hemorrhage of variable intensity, pain, localized warmth, swelling.
• Sprains: swelling, pain, limited joint mobility.
• Dislocations: pain, deformity, inability to move the joint.
• Fractures: severe pain, swelling, ecchymosis, deformity, functional impairment.
• Contractures: pain, stiffness, restricted movement.
• Thoracic trauma: severe pain, dyspnea, ecchymosis, decreased level of consciousness, hypotension, weak pulse, hemoptysis, diaphoresis, dizziness, cyanosis, tachycardia, abnormal breath sounds.

• Abdominal trauma:
• Closed: pain, abdominal distension, tachycardia, hypotension, nausea, vomiting, hematochezia, abnormal bowel sounds, bruising, cold skin, tachypnea.
• Open: bleeding wound, progressively worsening abdominal pain, distension, nausea, vomiting, shock (tachycardia, pallor, diaphoresis), hematuria or hematochezia, decreased bowel sounds.
• Traumatic brain injury: loss of consciousness, drowsiness, speech difficulty, repeated vomiting, loss of balance, limb weakness, persistent headache, neck stiffness, seizures, epistaxis or otorrhagia.
• Spinal trauma: severe pain, paresthesia, impaired limb mobility.
• Dental trauma: pain (especially on mastication), discoloration of the affected tooth, tooth mobility, increased sensitivity to temperature, gingival or lip swelling.

Psychological symptoms such as confusion, anxiety, or disorientation may also occur.

Causes

Trauma may result from different agents and is broadly classified into:

• Physical trauma: injuries caused by an external force.
• Mechanical trauma: resulting from movement or force exerted by a solid, liquid, or gas against the body, causing compression, stretching, torsion, or shear forces. Common in blows, falls, collisions, stab wounds, or gunshot injuries.
• Electrical trauma: caused by electric current passing through the body, such as electric shock or lightning strike.
• Thermal trauma: due to excessive heat or cold transfer (fire, heatstroke, contact with flammable liquids, prolonged cold exposure leading to hypothermia).
• Chemical trauma: tissue destruction resulting from contact with chemical substances.

Risk Factors

Severe trauma is frequently associated with:

• Age (young children and older adults).
• Contact or high-impact sports.
• Traffic accidents.
• Alcohol and drug use.
• High-risk occupations (machinery handling, construction, mining).
• Violent environments.
• Irregular surfaces.
• Poor lighting conditions.

Complications

Trauma may lead to severe complications, including:

• Post-traumatic osteoarthritis.
• Joint stiffness.
• Osteomyelitis.
• Chronic pain.
• Shock.
• Hemorrhage.
• Neurological damage.
• Vascular injury.
• Coma.
• Cerebral edema.
• Cognitive impairment.
• Post-traumatic epilepsy.
• Sensory disturbances (vision, hearing, smell).
• Paralysis.
• Sensory loss.
• Sphincter dysfunction.
• Pneumothorax (air in the pleural space).
• Hemothorax (blood in the pleural space).
• Respiratory failure.
• Cardiac tamponade.
• Empyema.
• Atelectasis.
• Aortic rupture.
• Multiorgan failure.
• Peritonitis.
• Intestinal obstruction.
• Hepatic or splenic rupture.
• Biloma (bile leakage into the peritoneum).
• Abdominal compartment syndrome.
• Internal hemorrhage.
• Intra-abdominal abscesses.
• Death.

Prevention

Although not always preventable, trauma risk may be reduced by:

• Adhering to traffic laws and speed limits.
• Using appropriate protective equipment (seat belts, helmets, goggles, mouthguards, reinforced footwear).
• Removing household obstacles.
• Ensuring adequate lighting.

What type of physician treats trauma?

Trauma management requires multidisciplinary collaboration involving Emergency department, Traumatology and orthopedic surgery, Internal medicine, Intensive care medicine, Neurosurgery, Neurology, Pulmonology, Cardiology, General and digestive system surgery, Dentistry, Physical medicine and Rehabilitation, Angiology and vascular surgery, Rheumatology, and Clinical psychology.