Orthopedic injuries of the lower limb and trunk in multiple system trauma.

There is a tendency in the patient who has suffered multiple injuries ot overlook the less obvious or less striking injury. The spine may be injured but the injury not recognized if the clues that are present on roentgenograms are ignored. There may be an increase in the interspinous distance with or without minor body compression in abdominal injuries due to seat-belts. Apparently minor fractures of transverse processes may indicate retroperitoneal injury severe enough to cause important urologic damage; when the 5th transverse process is fractured there may also be a fracture of the sacrum. Pelvic fractures may be accompanied by neurologic involvement. Fracture of the lower limb shaft does not eliminate the possibility of major disruption of knee ligaments. Swelling of the knee is the clue. An aggressive approach to the stabilization of fractures is advised, so that the treatment of other organs and reconstruction of blood vessels may more effectively be carried out. Compound fractures retain their high priority for early treatment, even in the presence of other important injuries.