Trauma (from the Greek trauma meaning “wound”) refers to structural and functional changes in the body that occur when an external force exceeds the tissue’s ability to resist damage.

Mechanical injuries can be:

  • Open trauma (where the skin or mucous membrane is broken)
  • Closed trauma (where the skin remains intact but internal damage occurs)
  • Catatrauma — injuries caused by falling from a height.

Usually, catatrauma involves damage to multiple organs, leading to what is called polytrauma (multiple injuries at once).

Types of trauma:

Based on the cause of injury:

  • Mechanical trauma
  • Thermal trauma (from heat or cold)
  • Chemical trauma
  • Electrical injuries
  • Psychological trauma
  • Barotrauma — usually happens after explosions; the blast wave can damage the middle ear (like a ruptured eardrum) and may also cause brain injuries such as concussion or brain contusion.

Mechanical traumas can be:

  • Open (wounds that break the skin)
  • Closed (skin remains intact)
  • Either uncomplicated or with complications such as infection, osteomyelitis (bone infection), sepsis, or traumatic toxicosis.
  • They may be isolated (affecting one organ or limb segment), multiple (several organs or limb segments), or combined (injuries to both internal organs and the musculoskeletal system).

Based on how long the injury lasts:

  1. Acute trauma (short-term)
  2. Chronic trauma (long-term)

Based on where and how trauma happens:

  • Occupational trauma: Injuries that happen at work or during commuting to/from work.
  • Military trauma: Divided into gunshot and non-gunshot injuries.
  • Sports injuries.
  • Iatrogenic trauma: Injuries caused during medical procedures, like catheter insertion.

Traumatism refers to the total number of injuries sustained by a specific group of people over a certain period of time.

There are different types of traumatism, such as:

  • General traumatism (measured per 1,000 people per year)
  • Occupational traumatism
  • Agricultural traumatism
  • Transport-related traumatism
  • Household traumatism, and others.

These types are usually expressed as percentages.

According to the World Health Organization (WHO), the number of injuries per 10,000 people varies between 9 and 15 annually across different countries. The USA has the highest number of injuries, mainly due to transportation development. Men are injured 2.1 times more often than women.

Most injuries are bruises and sprains, making up to 45% of all cases. Cuts and abrasions account for about 37%, while severe injuries make up 18%.

In the former USSR, the average injury rate was 13.5% per 100 workers, with an average of 25 days of work lost due to injury. In 1988, 19 million people were injured, 278,000 died, and 53,576 children were injured.

In most developed countries, trauma is the second leading cause of death. Polytrauma (multiple severe injuries) accounts for 9-15% of cases and is especially dangerous because it can lead to traumatic disease.

Traumatic disease occurs in 50-60% of all patients who have suffered polytrauma (multiple severe injuries). Depending on the severity, the death rate ranges from 10% to 90%.

The severity of traumatic disease depends on how severe the injury was. One way to judge injury severity is by whether the patient experienced shock, and if so, what degree of shock.

  • If there is no shock, traumatic disease does not develop.
  • If the injury causes first-degree (mild) shock, the injury is considered mild, and traumatic disease does not develop.
  • With moderate injuries, about 20% of patients may develop traumatic disease, and around 10% of those who get them may die.
  • For severe injuries with third-degree (severe) shock, traumatic disease affects all patients, but about 60% recover.
  • In injuries considered incompatible with life, the most severe form of traumatic disease develops, with a 90% death rate (meaning 1 out of 10 survives, so treatment is still important).

Recovery (convalescence) happens relatively slowly and there is no clear-cut end point. All damage from earlier stages needs to be treated and corrected. This recovery phase can last months or even years. Up to 60% of people who survive traumatic disease become permanently disabled.

Types of Injuries

Concussion (commotio):
A concussion is a jarring injury that usually doesn’t cause harm if it happens occasionally. However, repeated concussions can lead to vibration disease. Joints naturally help absorb shocks like these.

Dislocation (luxatio):
A dislocation is when the ends of bones in a joint are completely moved out of place, losing contact with each other. This usually happens due to trauma that tears the joint capsule and ligaments. Dislocations happen most often in the shoulder, less commonly in the hip, elbow, and ankle, and rarely from a bruise. Signs include bone misalignment, sharp pain, and inability to move the joint.
First aid: apply cold to the joint, give painkillers, immobilize the limb in its current position, and see a surgeon for relocation.

Bruise (contusio):
A bruise causes some cells to die and blood vessels to break, leading to bleeding under the skin like petechiae or hematomas (blood collections). Swelling occurs as part of inflammation. Function is disturbed due to pain and swelling but not completely lost.
First aid: apply cold to reduce bleeding and pain, use sprays like chlorethyl to freeze tissues, and immobilize the limb for a few hours up to 2-3 days. Diagnosis requires ruling out other injuries.

Sprain (distorsio) and Tear (ruptura):
These affect fibrous tissues like muscles, tendons, ligaments, and fascia. A sprain is a partial tear of some fibers without breaking the whole tissue. Blood vessels break causing bleeding and swelling. Pain is localized clearly. Surgery is not needed for sprains or bruises.

A tear means partial or full break of the tissue. A partial tear is called a rupture. Tears cause more bleeding, large hematomas, and sometimes muscle hernias (muscle bulging through the tear). Swelling and pain are severe, and function is lost—movement is impossible. Tears require surgery to restore function and immobilization for 2-3 weeks with medication to reduce swelling.

Fractures (fractus):
Fractures are broken bones. They can be:

  • Closed: skin is intact
  • Open: skin is broken, bone fragments visible
  • Complicated: with bleeding or tissue damage

Open fractures have a higher risk of infection.
Signs: pain, swelling, deformity, shortened limb, abnormal mobility, and bone cracking sounds.
First aid: immobilize the fracture, prevent or treat shock, and transport to a hospital quickly.

Crush Injury (compressio):
When a limb is compressed for a long time, a dangerous condition called crush syndrome or myorenal syndrome develops. Initially, there’s pain and shock, but pain may lessen after 1-3 hours. When pressure is released, shock returns and acute kidney failure often develops within days, which can be fatal.

This syndrome can also happen from prolonged pressure while unconscious (positional compression), often linked to alcohol or drug intoxication, requiring antidote treatment.
About 80% of crush syndrome cases involve thigh muscles. Muscle cells die, releasing harmful substances like myoglobin, potassium, creatinine, and enzymes into the bloodstream. These damage kidneys and cause swelling, blood thickening, lung edema, and poor oxygen exchange.