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The Shock Trauma Manual of Operative Techniques pp 367–388Cite as

Timing of Fracture Fixation

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Abstract

The ideal timing for the treatment of fractures remains controversial. In general, earlier treatment of fractures is advantageous because it facilitates mobilization of the patient, decreases the pain and systemic inflammatory response syndrome (SIRS) associated with unstable fractures, and simplifies care by removing splints, traction, and other limitations placed on the patient before surgery. However, this must be balanced with the potential danger of “second hit” fracture surgery that in itself could produce SIRS and poor outcomes. This chapter attempts to briefly summarize the current state of the literature and one center’s typical care for six of the more common orthopedic trauma issues. These six issues are treatment of fractures in the patient with polytrauma (with emphasis on timing of femoral nail insertion), open fractures, compartment syndrome, acetabular fracture surgery, hip fractures (both high energy and geriatrics), and flap coverage of mangled wounds.

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Acknowledgments

This chapter is a documentation of practices and thinking that are in place at one institution during one period of time. The text has therefore been profoundly influenced by the orthopedic attending surgeons who are practicing and contributing to the application of these ideas during this time period: Christina L. Boulton, M.D.; Carol E. Copeland, M.D.; W. Andrew Eglseder, M.D.; Christopher LeBrun, M.D.; Theodore T. Manson, M.D.; Jason W. Nascone, M.D.; Gregory Osgood, M.D.; Raymond A. Pensy, M.D.; Andrew N. Pollak, M.D.; Marcus F. Sciadini, M.D.; and Clifford H. Turen, M.D.

Jean Claude D’Alleyrand, M.D., assisted with the literature search in previous projects on several of these topics. Earlene Thomas assisted with manuscript preparation. Dori Kelly, M.A., senior editor and writer at the University of Maryland School of Medicine, edited the manuscript and formatted the figure files.

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Authors and Affiliations

  1. Orthopedic Trauma, R Adams Cowley Shock Trauma Center, Baltimore, MD, USA

    Robert V. O’Toole M.D.

  2. Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA

    Robert V. O’Toole M.D.

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  1. Robert V. O’Toole M.D.
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Correspondence to Robert V. O’Toole M.D. .

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Editors and Affiliations

  1. Department of Trauma, R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA

    Thomas M. Scalea

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O’Toole, R.V. (2015). Timing of Fracture Fixation. In: Scalea, T. (eds) The Shock Trauma Manual of Operative Techniques. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2371-7_20

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  • DOI: https://doi.org/10.1007/978-1-4939-2371-7_20

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