Management of orthopaedic injuries in polytrauma patients.

A ppropriate management of a polytrauma patient begins at the scene of the accident. Early initiation of Advanced Trauma Life Support (ATLS) protocols by emergency medical personnel and rapid transport to an appropriate facility is essential to maximize a patient’s chance of survival. Fifty percent of trauma deaths occur within minutes of the accident, usually due to hemorrhage or head injuries. Thirty percent of deaths occur within hours from similar causes. The remaining 20% of deaths occur days to weeks following the injury, typically from sepsis or multiple organ failure. For patients who have sustained major injuries, treatment at a designated regional trauma center that treats a significant volume of trauma patients has been shown to correlate with better survival rates. A large percentage of trauma patients have orthopaedic injuries. Management of isolated long bone fractures is relatively simple; however, treatment of these and more complex injuries (i.e., pelvis and acetabulum fractures) in the multiply injured patient is more challenging. Pelvis and long bone fractures cause significant systemic complications that affect the physiological status of the patient. These systemic effects will potentially alter the overall treatment of the patient. Orthopaedic injuries in the polytrauma patient must be addressed in the context of the entire patient, not just as isolated fractures.