Diagnosis and management of fractures in the multiply injured patient

Careful and frequent examination of the patient is critical to the success of treating the multiply injured patient. Many "occult" fractures are often missed initially because attention is focused on major, life-threatening injuries. It is essential that the various specialists treating the multiply injured patient communicate effectively among one another regarding priorities and proposed therapies. If one service anticipates operative management of a specific injury, it may be coordinated with orthopedic needs, fracture fixation, or reduction being carried out simultaneously. No patient should have orthopedic problems managed by benign neglect, even if the probability of survival is low. Many tragically injured patients do not survive the initial hours following an accident because of massive abdominal or intrathoracic injury. However, orthopedic management in all patients should be based on the assumption that the individual will survive. Maximum functional recovery should be expected in those who do survive, and thus necessitates careful planning of fracture treatment acutely and chronically.