Complex trauma: What you didn't know

Written by: Professor Mohamed Imam
Published: | Updated: 11/07/2023
Edited by: Sarah Sherlock

Trauma is the most common cause of death for individuals aged below 45 years and is the third most common cause of death regardless of age after heart disease and cancer. There are three different kinds of trauma, one being complex trauma. Expert consultant orthopaedic surgeon Professor Mohamed Imam provides us with a descriptive understanding of what complex trauma is.


Ambulance crew attending to patient who has physical trauma


What is complex trauma

The word “trauma” may be used in two different contexts, a physical and non-physical context. Regarding the physical context, there is a physical injury from an external agent made upon a person. When it comes to the psychological context, the term trauma means a deeply distressing or disturbing event that has caused an emotional response. Trauma can have lasting adverse effects on the individual’s functioning physical, social, and emotional well-being.

We can divide trauma into three main types:

Acute Trauma

It mainly results from a single event, such as a road traffic accident.

Chronic trauma

It occurs when someone is exposed to multiple, long-term, and/or prolonged traumatic events over a continued period of time.

Complex trauma

Complex trauma involves multiple trauma that can cause multiple fractures and dislocations, brain injuries, breathing problems, organ failure, blood loss, infection, permanent disability, or loss of limbs.



What are some of the most severe complex trauma injuries?

Over 50 per cent of total hospitalised trauma patients have possible limb-threatening or life-threatening musculoskeletal injuries, which may result in significant functional impairment.


Complex injuries can be physical or non-physical. Physical injuries include fractures, organ injuries, including lungs, liver, and kidneys. The risk of fracture depends, in part, on your age.


Life- and limb-threatening injuries, including massive bleeding from a pelvic fracture or multiple long bone fractures, complete arterial injury in an extremity, and compartment syndrome, are addressed emergently. In these circumstances, orthopaedic management is included in resuscitation efforts and promoting the survival of life and limb.


Open fractures are included in complex trauma injuries, and they should be debrided within the first 24 hours. Mechanically unstable spine, pelvis, acetabulum, and proximal and diaphyseal femur fractures benefit from or definitive stabilisation within the first 36 hours after injury.


Spinal cord injury (SCI) is among the most devastating types of traumatic injury. The lifetime cost of caring for a patient with SCI can reach 5 million pounds, and the global incidence and prevalence of SCI have changed little in past decades. Variations in causation and ethnicity are found between and within regions and countries.



How do complex trauma injuries occur?

Complex trauma can happen after:



How can complex traumas and preventable death be avoided?

We have been involved, as surgeons and scientists, in a lot of research to improve the outcomes of patients involved in complex trauma. Inappropriate management of complex trauma can create significant morbidity and mortality. Prevention is always the best strategy. However, this can only be achieved by the concerted efforts of the legislators, vehicle engineers, highway architects, proper trauma triage, and the development of trauma centres, as well as having efficient orthopaedic traumatologists.


Complex trauma can lead to death. A better understanding of the complex trauma is crucial to saving lives and limbs. Although, the rate of death underestimates the degree of the societal toll. Organised trauma systems have improved death by providing timely and expert care to severely injured patients. As well, patient management is comprised of rapid primary survey, focusing on the identification and treatment of immediate life-threatening injuries simultaneously.


Nowadays, we understand the “golden hour rule”; this is the window to treat potentially survivable life-threatening injuries. Approximately 60 per cent of preventable deaths occur in this time range.




If you have previously had a physical traumatic injury and would like a consultation, you can go to Professor Imam's Top Doctors profile and book a visit.

By Professor Mohamed Imam
Orthopaedic surgery

Professor Mohamed Imam is an exceptionally skilled consultant orthopaedic surgeon who specialises in upper limb surgery, sports injuries, and complex trauma.

Professor Imam uses the latest technology in diagnosing a wide range of upper limb conditions. He has gained leading expertise in the diagnosis and management of wrist, shoulder, hand and elbow conditions, and is highly skilled in the treatment of sports injuries. Among his repertoire of procedures are major shoulder tendon repair, upper body tendon tears, joint preservation, joint replacement, cartilage regeneration, and reconstruction surgery.

Furthermore, Professor Imam specialises in arthroscopic (keyhole) surgery to treat numerous conditions, including arthritistennis elbow (lateral epicondylitis)rotator cuff tears, frozen shoulder and tendonitis, as well as wrist and hand conditions such as Dupuytren's contracture and cubital tunnel syndrome

His extensive specialist training took place in the UK and internationally. In fact, he has been awarded multiple awards and international travelling fellowships, including a fellowship with Professor Christian Gerber, the world-leading pioneer of modern shoulder surgery, at Der Balgrist University Orthopaedic Centre of excellence in Zurich, Switzerland. What's more, he undertook travelling fellowships to gain up-to-date international experiences in Mayo Clinic, The Steadman clinic (the US Olympic team centre of excellence) and Stanford University.

Research is another area of Professor Imam's career. He is the chief investigator of leading national and international studies. His work is widely recognised, and he has published more than 70 peer-reviewed publications in top international medical journals and written more than 12 textbook chapters on upper limb injuries.

Professor Imam has accomplished many achievements throughout his career. He has designed orthopaedic instruments, designed and published different techniques, and authored two books. One of these books surrounding the theme of the use of stem cells in orthopaedics and another concerning shoulder arthroscopy. He regularly presents his research at various national and international meetings. Currently, Professor Imam, with an elite team of researchers, is investigating the use of artificial and machine intelligence in surgery.

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