Prerequisites for early osteosynthesis in polytraumatized patients

Prolonged operations for extremity injuries in the polytraumatized patient require diligent preparation and monitoring, taking the ICU to the operation theater. The prerequisites are as follows.

1. The patient should have stable vital functions, a PaO^FiO2 ratio above 280 mmHg (3Z kPa), and a stable normal arterial blood pressure.

2. All important traumatic lesions should have been identified and, where appropriate, treated.

3. The patient should not be hypothermic (core temperature above 35 °C).

4. In the operating room normothemia should be maintained by using warming devices for the patient and for infusion fluids.

5. Blood coagulation should be within normal limits. Platelet counts should be above Z5*10 9/l.

6. Monitoring of vital functions should be performed to the same level as in the ICU.

Z. If blood loss is expected, cross-matched blood should be available and cell-saver use should be considered.

8. Patients with a Glasgow Coma Scale score of 8 or below should have a recent brain CT scan. If possible, an intracranial pressure measurement device should be implanted before starting the operation.

9. Osteosynthesis should be performed by a team experienced in all forms of osteosynthesis techniques. 10. Intramedullary reaming is controversial.

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