Fracture Fixation Sequencing in Polyskeletal Trauma: Clinical Experience from a Five-Patient Retrospective Series

Area of Science:

• Orthopedic Surgery
• Trauma Management
• Skeletal Reconstruction

Background:

• Polyskeletal trauma with multiple long-bone fractures poses significant challenges for fracture fixation sequencing and timing.
• While early total care suits stable patients, damage control orthopedics (DCO) principles guide safer staged management in complex trauma.
• Limited evidence exists for optimal fracture sequencing in severe polytrauma.

Purpose of the Study:

• To review outcomes of individualized staged fixation strategies in patients with polyskeletal trauma.
• To evaluate the safety and efficacy of tailored approaches to managing multiple long-bone fractures.
• To explore factors influencing fracture fixation sequencing in complex trauma cases.

Main Methods:

• A retrospective case series of five adult patients with fractures of two or more long bones.
• Data collected included injury patterns, associated injuries, temporary stabilization, timing, and sequence of definitive fixation.
• Analysis focused on early outcomes and factors influencing surgical decisions.

Main Results:

• All patients initially received damage control stabilization (external fixation/splintage).
• Definitive fixation was staged after physiological optimization, with sequencing influenced by factors like pelvic instability, pulmonary/cardiac injury, and soft-tissue compromise.
• Fracture stabilization was achieved without major early implant-related complications.

Conclusions:

• Fracture sequencing in polyskeletal trauma necessitates an individualized, non-protocol-driven approach.
• A staged management strategy aligned with DCO principles facilitates safe definitive fixation while mitigating systemic physiological stress.