Nutritional Resuscitation in Patients With Orthopaedic Trauma: A Guide for the Practicing Orthopaedic Surgeon

» Postoperative nutritional optimization is an important, evidence-based intervention in trauma fracture care. Trauma induces a sustained hypermetabolic-catabolic response that overlaps with the critical phases of fracture healing, making early (within 24-48 hours) and structured nutritional intervention an opportunity for improvement in standard care. » A 12-week supplementation protocol is suggested for patients with operatively treated fractures. High-protein supplementation (1.5-2.0 g/kg/d for body mass index [BMI] <30; adjusted body weight-based dosing for BMI ≥30), vitamin D3 (cholecalciferol), calcium, and a multivitamin initiated postoperatively and continued through the hard callus phase may improve healing biology and reduce complications. » High-risk patients require enhanced and extended protocols with close medical follow-up and comanagement with an internal medicine physician or appropriate specialist. Elderly, malnourished, polytrauma, open fracture, and comorbid patients benefit from additional conditionally essential amino acids-that is, amino acids that the body can synthesize under normal conditions but cannot produce in sufficient quantities during metabolic stress (including arginine, glutamine, and branched-chain amino acids)-and wound-healing cofactors, with supplementation often continued for 6 months or until radiographic union. Arginine and glutamine should be used with caution in patients with chronic kidney disease (estimated glomerular filtration rate <60 mL/min/1.73 m2). » Monitoring and objective discontinuation criteria are important. Prealbumin (interpreted alongside C-reactive protein), albumin, and 25-hydroxyvitamin D should be reassessed at 2, 6, and 12 weeks, with supplementation discontinued only when laboratory values normalize, dietary intake recovers, and fracture healing progresses appropriately. Radiographic healing is not expected at 2 weeks; the 2-week visit focuses on nutritional markers and adherence assessment. » For osteoporotic fractures, nutritional optimization and maintenance of vitamin D status and calcium supplementation should be integrated into secondary fracture-prevention strategies and fracture liaison services.