Which fractures should be operatively fixed early

Dislocated joints should be repositioned as soon as possible, particularly if there is a pulse deficit. Fractures or fracture/dislocations of the spine, with progressive neurological deterioration, and depressed skull fractures take priority over other fractures. Fractures and joint injuries associated with vascular injuries should have a vascular supply provided within 6 h of injury. Open fractures and joint injuries should be treated within 6 h of injury because of the increasing risk of infection after this period. Operative stabilization of major joint reconstructions (i.e. of acetabular fractures and closed fractures of the forearm), bone grafting, and closure of large skin defects with skin grafts need not be carried out in the primary period.

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