[Timing of surgical treatment of fractures of multiply iniured patients - from science to tactics]

Abstract

Timing of the treatment of orthopaedic injuries in multiply injured patients has undergone changes. The timing of definitive fracture management has varied from several weeks to within hours of injury. In many studies a clear benefit has been identified from early definitive care of long bone fractures: early total care (ETC). The most seriously injured patients benefit from damage control orthopaedics, an approach employing primary external fixator stabilization followed by secondary intramedullary nailing. Debate over these approaches with enhanced understanding of biological response to injury has led to recent emphasis on the need for aggressive patient monitoring and continued multidisciplinary evaluation of the patient's physiological response to treatment.