Practice management guidelines for the optimal timing of long-bone fracture stabilization in polytrauma patients: The EAST Practice Management Guidelines Work Group

For several decades, there has been a debate regarding the optimal timing of long-bone fracture stabilization in polytrauma patients who may or may not have a brain or chest injury. Mixed injury group: Polytrauma patients undergoing long-bone stabilization within 48 hours of injury have no improvement in survival when compared with those receiving later stabilization; however, there may be some patients who will have fewer morbidities. There is no evidence that early stabilization has any detrimental effect. It is preferable to perform early long-bone stabilization in polytrauma patients. Brain injury group: There is no compelling evidence that early long-bone stabilization in mild, moderate, or severe brain injured patients either enhances or worsens outcome. The timing of long-bone stabilization should be individualized according to the patient's clinical condition. Clinical factors that may be relevant to determine the appropriateness of early long-bone stabilization include (a) severity of the brain injury (Glasgow Coma Scale score, brain computed tomographic scan findings, and intracranial pressure), (b) severity of pulmonary dysfunction (Pao2/FIO2, lung compliance, and positive end-expiratory pressure requirement), (c) hemodynamic status, (d) estimated operative time, (e) estimated blood loss, and (f) open or closed fracture status. Chest injury group: There is no compelling evidence that early long-bone stabilization in patients with chest injury either enhances or worsens outcome. The timing of long-bone stabilization should be individualized according to the patient' s clinical condition. Clinical factors that may be relevant to determine the appropriateness of early long-bone stabilization include (a) severity of pulmonary dysfunction (Pao2/FIO2, lung compliance, and positive end-expiratory pressure requirement), (b) hemodynamic status, (c) estimated operative time, (d) estimated blood loss, and (e) open or closed fracture status.