Polytrauma

Polytrauma describes a situation where a person has multiple serious injuries to different parts of the body at the same time. This often includes a combination of:

• Head or brain injury
• Spinal cord or spinal column injury
• Multiple fractures and soft-tissue injuries
• Chest, abdominal or pelvic trauma
• Psychological trauma

Most people with polytrauma are treated first in a major trauma centre or intensive care unit. Once they are medically stable, many still face significant physical, cognitive and emotional difficulties that limit independence and quality of life.

The Royal Buckinghamshire Hospital is an adult inpatient neurorehabilitation hospital. We provide specialist rehabilitation for people with polytrauma who have ongoing neurological, musculoskeletal and functional problems after the acute phase.

---

What Is Polytrauma?

Polytrauma usually refers to:

• Two or more serious injuries affecting different body regions or organ systems
• Injuries that together cause life-threatening or long-term disability
• A need for coordinated, multidisciplinary care during both acute and rehabilitation stages

Examples include:

• Traumatic brain injury with multiple limb fractures and chest trauma
• Spinal cord injury with pelvic fractures and internal injuries
• Complex orthopaedic injuries combined with nerve damage and soft-tissue loss
• Amputations with head injury and psychological trauma

Polytrauma is not a single diagnosis but a complex pattern of injuries and consequences that requires joined-up management over months or years.

---

Common Causes

Polytrauma is usually caused by high-energy events, such as:

• Road traffic collisions (car, motorbike, cycling, pedestrian)
• Falls from height
• Crush injuries or industrial/occupational accidents
• Assaults, including head injury and penetrating trauma
• Sports or recreational injuries involving high-speed impact
• Explosions or blast injuries

Many people have little or no memory of the incident itself, particularly when there is an associated traumatic brain injury or loss of consciousness.

---

Typical Injury Patterns

No two polytrauma patients are the same, but common patterns include:

Brain and Spinal Injuries

• Traumatic brain injury (from concussion to severe brain injury)
• Intracranial haemorrhage or contusions
• Diffuse axonal injury
• Spinal cord injury (complete or incomplete)
• Spinal fractures and ligament injuries

Orthopaedic and Soft-Tissue Injuries

• Multiple fractures in the upper and lower limbs
• Pelvic and acetabular fractures
• Complex joint injuries (shoulder, knee, ankle, wrist)
• Dislocations and ligament tears
• Soft-tissue damage, lacerations and crush injuries
• Amputations or limb loss

Chest, Abdominal and Pelvic Injuries

• Rib fractures and flail chest
• Lung contusions or pneumothorax
• Cardiac or great vessel injury (in the acute phase)
• Liver, spleen or other solid-organ injuries
• Bowel or bladder injuries
• Urological and gynaecological trauma

Psychological and Emotional Trauma

• Acute stress reactions
• Anxiety and depression
• Post-traumatic stress symptoms (flashbacks, nightmares, avoidance)
• Adjustment difficulties related to pain, disability and loss of roles

By the time patients reach a rehabilitation hospital, the focus has usually moved from life-saving treatment to maximising recovery and independence.

---

Long-Term Symptoms and Challenges

After the acute injuries have healed or stabilised, people with polytrauma often live with a mixture of:

Physical Problems

• Weakness and reduced endurance
• Stiffness, spasticity and contractures
• Persistent pain (musculoskeletal and/or neuropathic)
• Reduced range of movement in joints
• Balance problems and risk of falls
• Difficulty walking, transferring or using stairs
• Reduced fine motor skills and hand function
• Scar sensitivity and altered body image

Cognitive and Communication Difficulties

Particularly where there has been a brain injury, people may experience:

• Problems with concentration and attention
• Memory difficulties and “brain fog”
• Slowed thinking and processing speed
• Reduced planning, organisation and problem-solving (executive function)
• Word-finding difficulties or changes in speech
• Fatigue that worsens thinking and communication

Emotional and Behavioural Changes

• Low mood, anxiety and loss of confidence
• Irritability, emotional lability or personality change (especially after brain injury)
• Sleep disturbance
• Avoidance of places or activities that trigger memories of the trauma
• Relationship strain and changes in family roles

Functional and Social Impact

• Loss of independence in personal care and daily tasks
• Difficulty returning to work, study or driving
• Increased reliance on family, carers or care packages
• Challenges with housing, finances and benefits
• Need for equipment, home adaptations and ongoing therapy

These issues often interact: for example, pain and poor sleep increase fatigue, which then worsens mood and cognitive performance.

---

Acute Care vs Rehabilitation

In the acute phase, the priorities are:

• Stabilising vital signs and treating life-threatening injuries
• Surgical repair or stabilisation of fractures and internal injuries
• Intensive care, ventilation and monitoring where required

In the rehabilitation phase, once the person is medically stable, the focus shifts to:

• Understanding the combined effects of all injuries
• Restoring as much physical and cognitive function as possible
• Preventing complications (e.g. contractures, pressure damage, deconditioning)
• Planning for discharge home or to the next level of care
• Supporting emotional adjustment and long-term self-management

Rehabilitation for polytrauma is often more complex than for a single injury, because each element (brain, spinal, orthopaedic, psychological) affects the others.

---

Management and Rehabilitation

There is no single treatment that “fixes” polytrauma; instead, people require coordinated, multidisciplinary rehabilitation tailored to their specific injuries and goals.

Key components include:

Medical and Nursing Management

• Ongoing monitoring of medical stability and long-term complications
• Pain management, including neuropathic and musculoskeletal pain
• Spasticity management (medication, injections and therapy)
• Management of bladder, bowel and skin integrity
• Medication review to minimise sedation and side effects
• Liaison with surgical, orthopaedic, spinal and neurology teams as required

Physiotherapy

• Strength, balance and endurance training
• Gait re-education and mobility practice (with or without aids)
• Transfer training (bed, chair, car, toilet, bath/shower)
• Spasticity, contracture and posture management
• Respiratory physiotherapy where there has been chest trauma
• Stump conditioning and mobility training in amputee cases

Occupational Therapy

• Self-care skills (washing, dressing, grooming, toileting)
• Domestic activities (meal preparation, light housework, managing laundry)
• Assessment and provision of equipment and home adaptations
• Upper limb function and fine motor skills
• Fatigue and energy management
• Cognitive strategies for memory, attention and planning
• Support for return to work, education and driving where appropriate

Speech and Language Therapy

• Assessment and treatment of communication difficulties
• Cognitive-communication strategies (attention, memory, conversation skills)
• Swallowing assessment and management where there has been brain injury, facial trauma or prolonged intubation
• Support with alternative communication methods where required

Neuropsychology and Psychology

• Assessment of cognition, mood and behaviour
• Support for adjustment to injury, loss of roles and changes in identity
• Treatment for anxiety, depression and trauma-related symptoms
• Education for patients and families about brain injury and recovery
• Behaviour management strategies where there are cognitive or emotional changes

Social Work and Case Management

• Advice on benefits, housing and financial support
• Liaison with community services and local teams
• Input into long-term care planning and support packages
• Coordination with solicitors, insurers and case managers where litigation is ongoing

---

How We Can Help at The Royal Buckinghamshire Hospital

The Royal Buckinghamshire Hospital provides consultant-led inpatient rehabilitation for adults with polytrauma who have complex physical, cognitive and emotional needs after the acute stage of care.

We typically work with people who:

• Have sustained multiple injuries (for example, brain injury, spinal injury and multiple fractures)
• Are medically stable but have significant mobility, self-care or cognitive difficulties
• Have plateaued in acute or early rehabilitation but still have clear rehabilitation potential
• Need intensive, multidisciplinary input to plan for a safe and sustainable discharge home
• Are involved in serious injury litigation and require structured rehabilitation and clear reporting

Our Multidisciplinary Approach

Each inpatient programme is:

• Individualised – based on the person’s injuries, goals and context
• Multidisciplinary – rehabilitation medicine, nursing, physiotherapy, occupational therapy, speech and language therapy, neuropsychology and other specialists as required
• Goal-focused – with documented goals agreed with the patient and, where appropriate, family and case managers
• Time-limited – with clear review points, discharge planning and recommendations for ongoing community or outpatient support

We also:

• Work closely with families, carers and community teams
• Provide detailed reports on functional status, progress and ongoing needs
• Liaise with solicitors, insurers and case managers where requested

---

When to Seek Urgent or Ongoing Help

This page provides general information and does not replace individual medical advice.

You should call 999 immediately if you or someone else has been involved in a serious accident or has:

• Major wounds, obvious fractures or visible deformity
• Severe pain in the head, neck, chest, abdomen or pelvis
• Difficulty breathing, chest pain or coughing up blood
• Loss of consciousness, confusion or seizures
• Weakness, numbness or inability to move part of the body

After the acute phase, you should speak to your GP, hospital team or rehabilitation specialist if:

• You are struggling with ongoing pain, mobility, self-care or fatigue after multiple injuries
• There are persistent cognitive, emotional or behavioural changes after trauma
• You feel your recovery has stalled and may benefit from more intensive rehabilitation

They can advise whether community services, outpatient therapy or a period of inpatient rehabilitation at The Royal Buckinghamshire Hospital would be appropriate.