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| They don't do well |
When I was starting out we saw a lot of blunt polytrauma. A lot, sometimes with several badly injured people at once. It's much rarer now, and that's one of the many reasons to concentrate it in designated trauma centres, North American style.
Then we used to fix everything as early as possible, with plenty of 12 hour all-nighter sessions, which were fun in a masochistic way. You certainly felt you'd achieved something.
A few days later, in ITU, I would often wonder why, with lots of closed fractures, the patients got septic so easily, and why it was often Gram negative septicaemia. It kept them in for ages, if it didn't kill them
Which brings me to one of the most exciting (yes, I mean that) papers that I've ever read, by John Border, from the year before he died, 1995. Border explains it better than I can, with a chronological ride through 20th century trauma surgery. I once met a Swiss AO trauma surgeon who made his money as an expert in Nissen fundoplication. An alien concept to UK surgeons, but Border was also a general surgeon - in Buffalo - who ended up as an AO expert because he was determined to improve the management of trauma victims. He succeeded.
21 years on a lot of this is established practice and the lactate champions see it as commonplace, but back then it was revolutionary: fix fractures so they can sit up, breathe and eat. A magnificent (and beautifully written) testament to a great clinican, surgeon and researcher.
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