Pediatric Trauma Care in Austere Environments

Abstract

Standard principles of fracture care should be judiciously applied to the patients in the austere environment as well. In addition to shortcomings in the environment delivering care, inexperience and absence of proper expertise could seriously compromise safety and standards of care. Referral should always be considered a top priority in circumstances where there is doubt about the quality and competence of available treatment. The paradigm of “doing no further harm” should be respected while basic management is instituted and the child referred to appropriate institutions. Many times, the risks of maltreatment far outweigh the consequences of nontreatment.

Skeletally immature children have enormous remodeling capacity and this fact can be utilized to deliver what is judicious and avoid potentially hazardous complications of overzealous treatment. Most fractures in children will predictably unite, require shorter periods of immobilization, and can be managed by closed methods of treatment. Immobilized joints do not stiffen permanently. Fractures treated by closed methods may result in imperfect reduction, but regaining predictable function is possible. When modern technical skills are not available or applicable for one reason or another, time-tested simpler method of treatment can be used safely and unnecessary complications thus avoided.