Immediate multiple osteosynthesis in polytrauma

Thirty polytraumatized patients underwent immediate osteosynthesis of two or more long bone fractures for a total of 82 operations (plus an additional 14 for pelvis, hand, and foot fractures). Since 1983, according to the modern and rational concepts of "all at one time treatment", open fractures as well as associated closed lesions are stabilized immediately if the patient's general condition permits. This type of procedure requires adequate facilities as well as availability of and collaboration between teams of specialists, but it is inarguably advantageous for the patient (relief of pain, drastic reduction in the rate of embolism, improvement of respiratory and circulatory function, only one anesthesia), the surgeons (operation technically easier and shorter), and the ancillary medical personnel (easier nursing, rapid functional rehabilitation). The methods of osteosynthesis should be carefully selected in order to guarantee stability, rapid application, and low aggressiveness. The use of plates and screws is limited, while external fixation is employed frequently. Interlocked intramedullary nailing is adopted with increasing frequency. Review of cases treated by this method shows considerable improvement in terms of healing, functional recovery, and resumption of social and occupational activity.