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Malnutrition and Orthopedic Injuries

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Orthopaedic Trauma in the Austere Environment

Abstract

A significant correlation exists between malnutrition and the development of complications after orthopedic injuries. Impaired wound and bone healing, increased rate of wound infection, sepsis, progressive weakness, lethargy, delayed union/malunion, and delayed physical rehabilitation are all documented. The prevalence of patients malnourished or at risk for malnutrition among those hospitalized for orthopedic procedures goes up to 50 % in poor income countries, compared to 23–33 % in western countries. The post-trauma catabolic state is accentuated by the frequent period of food deprivation that commonly follows trauma. An optimal definition of malnutrition, especially in adults, is still lacking making sometimes difficult to recognize the subtle features of undernourishment. Currently, a simple clinical assessment of the patient’s status (subjective global assessment (SGA)) performed by an experienced physician may be considered reliable to sensibly estimate the nutritional state. Increasing the understanding of the role of nutrition in orthopedic trauma is therefore the first important step toward a successful outcome. Given the scarcity of resources, in the absence of oral supplementation with highly nutrient food, enteral nutrition is the alternative route of administration. This should be based on locally available food ingredients and not on sophisticated formulas or solutions imported from abroad. Micronutrients and immune-enhancing components, whose role is well acknowledged in western countries, are not widely available or used in austere and trauma settings.

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  1. Department of Surgical Sciences, Parma University Hospital, Parma, Italy

    Sandro Contini MD

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  1. Queen Elizabeth II Health Sci, Dalhousie University, Halifax, Nova Scotia, Canada

    Juan de Dios Robinson

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Contini, S. (2016). Malnutrition and Orthopedic Injuries. In: Robinson, J. (eds) Orthopaedic Trauma in the Austere Environment. Springer, Cham. https://doi.org/10.1007/978-3-319-29122-2_11

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