What factors determine a “major fracture”?

Abstract

In the treatment of polytraumatized patients, the term “major fracture” has been frequently used to determine those that require special attention. Historically, the femur fracture has been in focus [ [1] Tscherne H. Oestern H.J. Sturm J. Osteosynthesis of major fractures in polytrauma. World J Surg. 1983; 7: 80-87 Crossref PubMed Scopus (33) Google Scholar , [2] Schreiber V.M. et al. The timing of definitive fixation for major fractures in polytrauma–a matched-pair comparison between a US and European level I centres: analysis of current fracture management practice in polytrauma. Injury. 2011; 42: 650-654 Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar ]. More recently, the introduction of risk adapted surgical strategies, such as the safe definitive surgery concept, have integrated several aspects of management [ 3 Pape H.C. Pfeifer R. Safe definitive orthopaedic surgery (SDS): repeated assessment for tapered application of early definitive care and damage control?: an inclusive view of recent advances in polytrauma management. Injury. 2015; 46: 1-3 Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar , 4 Pape H.C. et al. Options and hazards of the early appropriate care protocol for trauma patients with major fractures: Towards safe definitive surgery. Injury. 2016; 47: 787-791 Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar , 5 Giannoudis P.V. Giannoudis V.P. Horwitz D.S. Time to think outside the box: 'Prompt-Individualised-Safe Management' (PR.I.S.M.) should prevail in patients with multiple injuries. Injury. 2017; 48: 1279-1282 Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar ]. Among these is the inclusion of multiple parameters (coagulation, acid base status, degree of shock and inflammation) and expand on assessing these as serial measurements [ [6] Hietbrink F. et al. Modulation of the innate immune response after trauma visualised by a change in functional PMN phenotype. Injury. 2009; 40: 851-855 Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar , [7] Halvachizadeh S. et al. How to detect a polytrauma patient at risk of complications: a validation and database analysis of four published scales. PLoS One. 2020; 15e0228082 Crossref Scopus (31) Google Scholar ], as repeated measurements [ [8] Dezman Z.D. et al. Failure to clear elevated lactate predicts 24-hour mortality in trauma patients. J Trauma Acute Care Surg. 2015; 79: 580-585 Crossref PubMed Scopus (45) Google Scholar ] for patient assessment are superior to a single one on admission.