Does early fixation of fractures reduce mortality in severely injured patients?

It is commonly believed that fixation of fractures as soon as possible after injury reduces mortality and the incidence of pulmonary complications. This belief is supported by a large number of published studies. An audit of 200 patients with severe, multiple injuries performed at the Birmingham Accident Hospital demonstrated that mortality was not influenced by the method of fracture management. The literature relating fracture management to mortality and the incidence of pulmonary complications is critically reviewed and alternative explanations for the apparent benefits of early fracture fixation are discussed. It may be concluded that for patients with severe, multiple injuries which include fractures, early fracture fixation may not be helpful and in certain cases may even be harmful. Although patients undergoing early fracture fixation appear to do better in many institutions, the key feature producing this beneficial outcome may be prompt and accurate resuscitation followed by sophisticated monitoring permitting early detection and prompt treatment of hypoxia and hypovolaemia.