Special considerations in polytrauma patients

Life-threatening injuries are treated before limb-threatening injuries. To reduce the time spent in the operating room, external fixation without anatomical reposition may be preferred over anatomical reposition and internal osteosyntheses. A definitive operation is performed at a later stage to achieve the optimal result.

The patient with an isolated extremity injury benefits from active exercise, muscle training, or early weight bearing to gain functional recovery of the injured limb at an early stage. Thus the occurrence of complications such as muscle wasting, joint stiffness, and thromboembolic disease is reduced. Polytraumatized patients require early and intensive physiotherapy, including early active and/or passive movement of the injured and uninjured limbs. Continuous passive movement devices are useful, particularly for joint injuries. Passive exercises, together with the application of removable splints or external fixators, should prevent joint contractures. The patient should undergo an intensive rehabilitation program, if necessary in a rehabilitation center.

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