Fracture treatment for the multiply injured patient

Multiply injured patients are benefited by an intradisciplinary approach to treatment. Consultants provide expertise in the treatment of particular injured systems. Resuscitation and diagnostic evaluation are life-saving priorities of treatment in the emergency room. Definitive surgical treatment of body cavity injury is combined with careful monitoring while the patient is under anesthesia. The orthopaedic surgeon's responsibility then is to stabilize the fractures, thus minimizing the risk of infection, lung failure, and debilitation so that the patient may be gotten out of bed and rehabilitation started. Prolonged recumbency is probably the worst thing that can happen to a traumatized patient. The goal of fracture treatment is bone union without infection and with stable soft tissue coverage and normal motion of associated joints. It is important to realize that in these multiply injured people, fractures of the femoral or tibial shafts and unstable pelvic fractures threaten survival and should be surgically treated as soon as feasible. The operative treatment of fractures of the humerus, forearm, knee, and ankle can be addressed on an emergent basis. The condition of the skin around the ankle and knee influences the timing of surgery; a 24-hour delay may preclude surgery for weeks because of swelling and blisters. Orthopaedic surgeons now are beginning to understand the concepts of spine instability and have devices to stabilize the fractures. We think that unstable fractures should be given the same priority that fractures of major long bones receive. Free vascularized tissue provides excellent coverage when skin loss occurs over the distal two-thirds of tibial fractures.(ABSTRACT TRUNCATED AT 250 WORDS)