Adult trauma: getting through the night

It is now recognized that the treatment of many orthopaedic injuries can be, and in many cases should be, deferred until a later date. For example, surgical repair of most fractures of the proximal and distal tibia is now delayed until soft-tissue healing has occurred. Acute treatment involves only provisionally reducing and stabilizing such fractures using a joint-spanning external fixator. However, situations occur in the emergency department in which emergency treatment, even if it is just temporizing in nature, must be done immediately. Often, such treatment is outside the comfort zone of the responsible orthopaedic surgeon, even physicians with training and experience in orthopaedic trauma. Orthopaedic surgeons will benefit from updated information on current methods for the emergency management of limb- and/or life-threatening injuries in adults. Such treatment is often provisional in nature, treating only the urgent component of the injury (such as a compartment syndrome associated with a complex tibial plateau fracture). It is important for orthopaedic surgeons to understand how to get "through the night" so that later appropriate definitive care is facilitated to optimize patient outcomes.