Article

Politraumatismo del niño

EMC - Aparato Locomotor 05/2012; 45(2):1–8. DOI: 10.1016/S1286-935X(12)61897-8

ABSTRACT Los traumatismos graves provocan un tercio de la mortalidad infantil. El 30% de los fallecimientos por esta causa, que se consideran evitables, se produce pocas horas después del accidente. Para tratar de disminuir el número de fallecimientos evitables se necesita la intervención de un equipo especializado y una estrategia terapéutica óptima. El conocimiento de las características anatómicas y fisiológicas del niño es fundamental para poner en marcha tal estrategia. La atención médica comienza en la etapa prehospitalaria con la búsqueda, la valoración y el tratamiento de las dificultades vitales inmediatas. Continúa en un centro hospitalario infantil preparado para la atención de niños politraumatizados, en el que se evalúan las lesiones según un orden cronológico de gravedad decreciente. Por último, se emprende el tratamiento de todas las lesiones. Una estrategia terapéutica óptima no es posible sin la acción conjunta de todos los facultativos a cargo de la atención del paciente, bajo la dirección de un médico coordinador que, por regla general, es el especialista en reanimación. Desde el punto de vista ortopédico, las indicaciones de osteosíntesis son más amplias que de costumbre. El objetivo es poder movilizar al paciente de forma segura, evitar las complicaciones por decúbito y facilitar la colocación de vías de acceso como, por ejemplo, un tubo de drenaje torácico. La urgencia ortopédica atañe sobre todo a la columna vertebral, las fracturas abiertas de los miembros, el síndrome compartimental y las fracturas con complicaciones vasculares. Las otras fracturas pueden tratarse dentro de las primeras 48 horas, sin olvidar las fracturas menores, que pueden pasar inadvertidas y dejar secuelas que deberán tratarse posteriormente.

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