Timing of osteosynthesis

Performing operative stabilization of major fractures (pelvis, femur) on the day of injury is an attractive option. The young and active trauma patient is still in optimal nutritional and immunological condition. This condition will deteriorate during the following days or weeks, with colonization by nosocomial bacteria, infectious complications, and wound infection increasing the risks of secondary surgery. The presence of one or more 'floating' major fractures makes nursing difficult and the patient uncomfortable. Stabilizing fractures allows optimal nursing, as the patient can be moved and turned, preventing decubitus, and mobilization can be started. Since fewer analgesics are needed, the patient is more alert. Thus active mobilization should start at an early stage, as a prerequisite for the prevention of thromboembolic complications and for attaining optimal functional outcome of the fractured extremities.

In severely traumatized patients, 90 per cent of late deaths are caused by the acute respiratory distress syndrome and the multiple organ dysfunction syndrome. An important factor, correlating with late death, is the presence of one or more major fractures which have not been stabilized by external or internal fixation. Early osteosynthesis in polytraumatized patients results in a reduction in morbidity and mortality, because of a lower incidence of acute respiratory distress syndrome and sepsis, and fewer ventilator and ICU days (Biert...a.nd G.oiis..!995).

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