National reports published annually by Transport Research Wing of the Ministry of Road Transport & Highways and National Crimes Records Bureau of Ministry of Home Affairs, Government of India describe national statistical trends and normalized indicators of road accidents, injuries & fatalities. This article highlights trends, indicators, interstate comparisons and the latest characteristics of road traffic accidents in India. While the official road traffic fatality data may be close to the actual number, the injury data are gross underestimates. As per bibliometric analysis, India contributed only 0.7 per cent papers on road traffic injuries and had less than one article on road traffic injuries per 1,000 road traffic related deaths. To be effective, policies on injury prevention and safety must be based on local evidence and research. Health professionals and their professional bodies across wide disciplines need to take an initiative for the same with active commitment.

Polytrauma remains the leading cause of death and disability in children and young adults. Systematic organized team effort is essential for improving the survival in trauma victims. Initial assessment includes preparation, triage, rapid primary survey and resuscitation, secondary survey and definitive care. ABCDE of primary survey includes airway maintenance with cervical spine control, breathing and ventilation. Circulation and hemorrhage control, disability and exposure with prevention of hypothermia. Secondary survey includes head to toe examination of the trauma patient including a complete history and physical examination and reassessment of all vital signs. Definitive care may involve shifting the patient to radiology/operating room/intensive care unit.

Management of thoracic trauma is an integral part in the decision making process for damage control in a case of polytrauma. Approximately 25% of civilian trauma deaths are caused by thoracic trauma and many of these deaths can be prevented by prompt diagnosis and correct management. The article discusses in brief a protocol for management of polytrauma with special emphasis towards thoracic trauma.

In this era of modern mechanization of the world, the incidence of poly trauma is increasing every day. Abdominal and pelvic trauma resulting in concealed hemorrhage is the main cause of mortality following poly trauma. Most of these deaths can be prevented by early diagnosis and prompt management of the underlying cause of hemorrhage. Identification of the victims with persistent hemodynamic abnormality in need of early surgical intervention is essential for a better patient outcome. Focused assessment with sonography in trauma is a useful bedside tool that aid in early identification of patients with intra-abdominal hemorrhage. Computed tomogram of the abdomen is the preferred diagnostic modality in the management of hemodynamic normal patients. Damage control surgery is beneficial in the subset of patients with depleted physiologic reserve and hemodynamic abnormality

Head injury is a major cause of mortality and morbidity throughout the world. Fortunately, majority of patients suffer from mild head injury and escape the disabling sequelae. Glasgow coma scale remains an effective method for initial assessment as well as subsequent progress of the patient. Intensive care management with efforts to minimize the secondary brain injury reduces the magnitude of disability. Prevention strategies through education, use of safety methods and enforcement of laws will help in decreasing the incidence of primary brain injury.

It has been found that many orthopaedic patients who have sustained multiple injuries benefit from the early total care of major bone fractures. However, early surgery has been found to be harmful to some multiply injured patients. Damage control orthopaedics is an approach that contains and stabilizes orthopaedic injuries so that the patient's overall physiology can improve. Its purpose is to avoid worsening of the patient's condition by the "second hit" of a major orthopaedic procedure and to delay definitive fracture repair until a time when the overall condition of the patient is optimized. The article deals with principles involve in damage control orthopaedics pertaining to diagnosis and management.

Acute spinal cord injury primarily affects young otherwise healthy people and is a major cause of patient morbidity and a source of significant health care expenditure. The priority in the management of spinal injury in a patient with polytrauma is to minimize secondary mechanical or physiological insults to the spinal cord. Identification of spinal injuries during initial trauma evaluation is challenging, as patients often have a reduced level of consciousness due to other injuries or are under the influence of sedative and/or analgesic medication. The management of suspected spinal cord injury in patients with polytrauma involves early immobilization of the whole spine and the institution of measures to prevent secondary injury from hypoxia, hypoperfusion or further mechanical disturbance. All spinal injuries should be considered unstable and incomplete until proven otherwise. Careful and informed neurological assessment, together with appropriate plain radiography, will identify the majority of spinal injuries. Early surgical decompression should be considered. Improvements in motor vehicle safety and traffic regulations can result in a marked reduction in spinal cord injury due to motor vehicle accidents with significant reduction in mortality attributable to spinal injury. A robust system of care is the best assurance of good health outcomes and reasonable health for people with spinal cord Injury.

Patients with polytrauma can sustain significant injuries to the ears , nose and neck. Injuries in this region can present with life threatening bleeding and airway problems. Prompt and optimum management of these injuries is required for a successful outcome. In this article we enumerate the various otolaryngologic injuries and their management.

Ocular trauma is the leading cause of monocular blindness accounting for up to 40%. It can occur in all age groups, most frequent being young males. The incidence of penetrating eye injuries is 3.6 per lakh, while those requiring hospitalization is 15.2 per lakh. Common sources of injury include blunt objects, sports, and road traffic accidents. The current article deals with the examination and management of an ocular emergency in a polytrauma patient.

Among the myriad injuries seen in the emergency department, facial trauma is one of the most common. Trauma to the maxillofacial area mandates special attention. Due to their close proximity and frequent involvement, the vital structures in the head and neck region must be evaluated whenever the head and face are injured. Medical literature suggests that early repair of facial injuries, within hours or days, results in better outcomes for function and appearance.

The burn patients need a very special care as besides skin burn; they can have associated mechanical injuries, inhalational injury and altered physiology with the risk of hypothermia. Once the patient survives from the acute phase, the appropriate wound management is the further challenge. The psychological trauma starts from time of injury to long after survival. Thus focused approach of burn patients allows critical care support, early surgical excision and closure of the burn wounds, patient and family psychosocial support, patient and family education, continuous long-term rehabilitation, re-entry into the society and reconstructive surgical needs.

Trauma is still the leading cause of death in children above one year of age even in countries with the most advanced medical services. Multiple trauma is always more than the sum of the single injuries; it should be considered as a systemic disease. Injury mechanisms vary with age. In infants non - accidental injuries (NAI) are common and are at higher risk for sustaining injury in the home environment. Fall is also major a cause of injury and home is the common place of injury. In caring for injured children the health care provider must be aware of the unique anatomic and physiological characteristics. This article is focused on these aspects only.

Trauma during pregnancy is an important cause of nonobstetrical cause of maternal mortality & morbidity. Apart from type of injury affecting the maternal & fetal outcome there are several life threatening complications unique to pregnancy like abruption placentae, uterine rupture, amniotic fluid embolism, & direct fetal trauma which needs immediate interventions. Maternal assessment & management during pregnancy needs special consideration to physiological changes during pregnancy as well as fetal surveillance to improve the maternal & fetal outcome. All pregnant trauma patient needs multi disciplinary approach involving obstetrician, neonatologist, obstetric anaesthetist & trauma surgeons.

Background: Titanium elastic nailing has emerged as a treatment of choice for stabilization of paediatric diaphyseal femoral fractures. Materials and Methods: Between 2007 and 2012, we treated 18 fractures of the femur using closed titanium elastic nailing (TEN),in pediatric patients. This study was done as a retrospective study on 18 cases of fracture of the femoral diaphysis, operated between 2007 and 2010. An assessment of the available postoperative radiographs revealed 88.8% (16 of 18) of the fractures had nails, which formed a divergent C configuration; cortical contact by both nails was visible in 77.7% (14 of 18) and the nails crossed above and below the fracture site in 83.3% (15 of 18). Results: The final outcome was adjudged as excellent when there was anatomical or near anatomical alignment with no postoperative problems in 61.1% (11 of 18) of the patients, satisfactory when there was acceptable alignment and leg length, with resolution of postoperative problems in 22.2% (4 of 18) of the cases, and poor in the presence of unacceptable alignment or leg length, with unresolved postoperative problems in 16.6% (3 of 18) of the cases. Minor or major complications occurred in seven patients. Poor outcomes were due to limb length discrepancy> 2 cm in one1 patient (5.5%), rotational deformity in one patient (5.5%), and varus malunion in one patient (5.5%). Conclusion: We recommend TEN in pediatric patients.

Introduction: Fracture of humeral shaft are commonly encountered by an orthopedic surgeon and accounting for approximately 3-5% of all fractures. we conducted a prospective comparative study of surgical stabilisation of diaphyseal humerus fracture by locking compression plate with stack nailing a very low cost method of treatment. Materials and Methods: 60 consecutive patients operated with either locking compression plating or stack nailing for acute fractures of shaft humerus during the period from 2009 to 2011 with minimum follow-up of 12 months were included in the present analysis. Results: Five out of the sixty patients showed non-union (1 in plating and 4 in stack nailing). Conclusion: We conclude from the study that locking compression plating is the preferred method in the majority of fractures of the shaft of the humerus with better preservation of joint function and lesser need for secondary bone grafting for union and with better preservation of joint function.

Aim: This prospective study was conducted to know the outcome of percutaneous lateral pinning in the management of displaced supracondylar fracture of humerus in children. Settings and Designs: Prospective study. Materials and Methods: Eighty five patients with displaced supracondylar fractures admitted between July 2005 and July 2010 were recruited into the study. All patients were operated under general anesthesia within 24 h after trauma using the percutaneous 2-lateral pin fixation (n = 85). Results were analyzed using Flynn's criteria. All patients were followed up to 6 months post-operatively. Results: Eighty five displaced supracondylar fractures of humerus, aged between 1½ year and 13 years, were treated using close reduction and percutaneous Kirschner (K) wire fixation under the c-arm image intensifier. Above elbow plaster of paris back slab was applied in all cases for at least 4 weeks. The slab and K-wires were removed after 4 weeks and elbow range of motion exercise was started. 68.23% had excellent, 29.40% good, 1.17% fair and 1.17% had poor results at 8 ^th weeks, which was improved to 91.75% excellent, 7.05% good, 1.17% fair and no poor result at final follow-up. There was no iatrogenic neurological injury either for the ulnar or for the radial nerves. Five patients developed superficial pin tract infection post-operatively and were treated conservatively with good healing and no long-term sequelae. Conclusion: Closed reduction and percutaneous lateral pinning proved an efficient, reliable, and safe method in the treatment of displaced supracondylar fractures of the humerus in children.

Osteopoikilosis is a rare hereditary condition present as an autosomal dominant trait in families, but can also present as sporadic cases. It is an asymptomatic condition; incidental radiological finding play an important role in its diagnosis. These are symmetrically distributed numerous small, well-defined, homogenous, circular or ovoid radio-densities clustered in epiphysis and metaphysis of long bones in periarticular regions. There is no age and sex affinity; age at the time of diagnosis range from 15 to 60 years. There are no specific clinical features; histological features are similar to the bone island and it may be associated with connective tissue disorders, synovial osteochondromatosis and a rare bone disease melorheostosis; genetically LEMD3 gene mutations are responsible for it. Osteopoikilosis must be differentiated from osteoblastic metastasis, synovial chondromatosis, tuberous sclerosis and mastocytosis. There are three rare complications, which have been reported like-spinal stenosis, dacrocrystitis and malignant transformation.

Open fractures of the tibia/fibula are common in renal tubular acidosis patients and may be fraught with complications such as malunion, delayed union, non-union, infection, deformity, bone loss and dead and necrotic bones. The Ilizarov method, as originally described for lengthening, treatment of non-union and bone transport, does not involve the use of bone-grafting at the docking site to aid rapid healing. The most common complication is non-union of the docking site. In this report, we present a case of 18-year-old man with open fracture tibia/fibula treated initially with unilateral external fixation and followed by Ilizarov's distraction osteogenesis technique for skeletal defect created after adequate debridement and resection of the necrotic bone as a result of open fracture. We aimed to demonstrate the success of docking site augmentation of iliac crest cancellous bone graft has been shown to rapid consolidation, decrease the rate of non-union and decrease the time of prolonged fixator use with respect to patient compliance managing complex frame adjustments.