INTERNAL-FIXATION OF MULTIPLE FRACTURES IN PATIENTS WITH POLYTRAUMA

Within the last decade understanding of the pathogenetic consequences of trauma has been improved significantly An additional reduction of l ethality has been achieved that in part is related to increasing discr imination of complex injury patterns, Accordingly, additional staging in fracture management of these injuries has been developed, An overvi ew of the current status of fracture management in polytrauma is given and certain regimens that are still controversially are discussed, Th e principles determined are based on the treatment experience of 4003 multiply injured patients within the past 23 years, The most important principles within the first hours after trauma represent adequate hem orrhage control, In fracture treatment the primary goal remains to per form primary stable osteosynthesis, In severe polytrauma with severe i njuries to the extremities, the first decision is whether limb salvage can be achieved without risk of deterioration of the patient's condit ion, If this is the case, open fractures Grades III b and c usually ca n be stabilized primarily by unreamed intramedullary nailing or percut aneous plating, The priority pattern in multiple closed fractures is a s follows: (1) tibia; (2) femur; (3) pelvis; (4) spine; and (5) upper extremity, Exceptions may ensue if severe head or thoracic trauma is p resent, Delayed treatment is performed for complex joint reconstructio n, definitive treatment of maxillofacial injuries, and soft tissue rec onstruction.