Fracture Management

Musculoskeletal injuries are common in polytraumatized patients. Over the last decades, the treatment strategies and management of fractures in critically injured have changed. The indication for early definitive treatment includes the assessment on the dynamic response to resuscitation and evaluation of the “Four Vicious Cycles” (hemorrhagic shock, hypothermia, coagulopathy, and soft tissues). Along with the goal of stabilizing major fractures as early as physiologically safe, “Safe Definitive Surgery” (SDS) concept has been introduced, which is a dynamic synthesis of both strategies (Early Total Care (ETC) and Damage Control Orthopedics (DCO)). This concept does not rule out the use of ETC or DCO, but rather put it in perspective of the clinical situation considering the dynamics of the clinical course. Due to repeated reevaluation and assessment of the patients regarding their physiology, dynamic classification, and adaptation of the treatment strategy is possible. The following chapter elucidates the stages of treatment in polytrauma, management strategies in musculoskeletal injuries, and relevant assessment of soft tissues/concomitant injuries.