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Treating orthopedic and related soft-tissue injuries can be problematic when medical equipment is scarce, especially in settings with high levels of injury (e.g., wilderness, war) or where having a disability is a threat to survival (e.g., treks, battles, subsistence economies). Extremity injuries are the primary cause of injury-related disability in many countries, especially in the developing world.1 In developed countries, they account for about 6% of all adult emergency department visits.2

The World Health Organization (WHO) has developed a list of essentials for treating extremity trauma at facilities with different levels of treatment capability throughout the world (see the “Facilities” section in Chapter 5). Table 32-1 suggests what equipment and skills may need to be improvised in situations of scarcity.

TABLE 32-1Worldwide Essentials for Diagnosing and Treating Extremity Injuries

This chapter discusses the diagnosis and treatment of fractures and dislocations, including emergency amputations.


Lacking radiographs or other imaging capability, clinicians need to rely on physical signs and symptoms to make presumptive diagnoses of fractures and dislocations. Table 32-2 lists the common signs and symptoms of fractures, with a comment about their diagnostic utility. Radiographs and ultrasound are included in the list to identify their relationship with the physical examination. Many factors affect the usefulness of imaging as a diagnostic tool, including its technical quality and the skill of those interpreting the images.

TABLE 32-2Usefulness of Clinical Information for Diagnosing Fractures (10 = Most Useful, 1 = Least Useful)

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