Early Fracture Stabilization Research Articles

Timing matters: Early versus late rib fixation in patients with multiple rib fractures and pulmonary contusion

BackgroundRecent literature has shown that surgical stabilization of rib fractures benefits patients with rib fractures accompanied by pulmonary contusion; however, the impact of timing on surgical stabilization of rib fractures in this patient population remains unexplored. We aimed to compare early versus late surgical stabilization of rib fractures in patients with traumatic rib fractures and concurrent pulmonary contusion. MethodsWe selected all adult patients with isolated blunt chest trauma, multiple rib fractures, and pulmonary contusion undergoing early (<72 hours) versus late surgical stabilization of rib fractures (≥72 hours) using the American College of Surgeons Trauma Quality Improvement Program 2016 to 2020. Propensity score matching was performed to adjust for patient, injury, and hospital characteristics. Our outcomes were hospital length of stay, acute respiratory distress syndrome, unplanned intubation, ventilator days, unplanned intensive care unit admission, intensive care unit length of stay, tracheostomy rates, and mortality. We then performed sub-group analyses for patients with major or minor pulmonary contusion. ResultsWe included 2,839 patients, of whom 1,520 (53.5%) underwent early surgical stabilization of rib fractures. After propensity score matching, 1,096 well-balanced pairs were formed. Early surgical stabilization of rib fractures was associated with a decrease in hospital length of stay (9 vs 13 days; P < .001), decreased intensive care unit length of stay (5 vs 7 days; P < .001), and lower rates of unplanned intubation (7.4% vs 11.4%; P = .001), unplanned intensive care unit admission (4.2% vs 105%, P < .001), and tracheostomy (8.4% vs 12.4%; P = .002). Similar results were also found in the subgroup analyses for patients with major or minor pulmonary contusion. ConclusionThese findings suggest that in patients with multiple rib fractures and pulmonary contusion, the early implementation of surgical stabilization of rib fractures could be beneficial regardless of the severity of pulmonary contusion.

Effect of uncertain clinical conditions on the early healing and stability of distal radius fractures

Background and objectivesThe healing outcomes of distal radius fracture (DRF) treated with the volar locking plate (VLP) depend on surgical strategies and postoperative rehabilitation. However, the accurate prediction of healing outcomes is challenging due to a range of certainties related to the clinical conditions of DRF patients, including fracture geometry, fixation configuration, and physiological loading. The purpose of this study is to investigate the influence of uncertainty and variability in fracture/fixation parameters on the mechano-biology and biomechanical stability of DRF, using a probabilistic numerical approach based on the results from a series of experimental tests performed in this study. MethodsSix composite radius sawboneses fitted with titanium VLP (VLP 2.0, Austofix) were loaded to failure at a rate of 2 N/s. The testing results of the elastic and plastic behaviour of the VLP were used as inputs for a probabilistic-based computational model of DRF, which simulated mechano-regulated tissue differentiation and fixation elastic capacity at the fracture site. Finally, the probability of success in early indirect healing and fracture stabilisation was predicted. ResultsThe titanium VLP is a strong and ductile fixation whose flexibility and elastic capacity are governed by flexion working length and bone-to-plate distance, respectively. A fixation with optimised designs and configurations is critical to mechanically stabilising the early fracture site. Importantly, the uncertainty and variability in fracture/fixation parameters could compromise early DRF healing. The physiological loading uncertainty is the most adverse factor, followed by the negative impact of uncertainty in fracture geometry. ConclusionsThe VRP 2.0 fixation made of grade II titanium is a desirable fixation that is strong enough to resist irreparable deformation during early recovery and is also ductile to deform plastically without implant failure at late rehabilitation.

Trauma

The August 2023 Trauma Roundup360 looks at: A comparison of functional cast and volar-flexion ulnar deviation for dorsally displaced distal radius fractures; Give your stable ankle fractures some AIR!; Early stabilization of rib fractures – an effective thing to do?; Locked plating versus nailing for proximal tibia fractures: A multicentre randomized controlled trial; Time to flap coverage in open tibia fractures; Does tranexamic acid affect the incidence of heterotropic ossification around the elbow?; High BMI – good or bad in surgical fixation of hip fractures?

Evaluating the impact of timing to rib fixation in patients with traumatic brain injury: A nationwide analysis.

Early surgical stabilization of rib fractures (SSRF) is associated with improved inpatient outcomes in patients with multiple rib fractures. However, there is still a paucity of data examining the optimal timing of SSRF in patients with concomitant traumatic brain injury (TBI). This study aimed to assess whether earlier SSRF was associated with improved outcomes in patients with multiple rib fractures and TBI. We performed a retrospective analysis of the American College of Surgeons Trauma Quality Improvement Program 2017-2020, including adult patients with TBI and multiple rib fractures who had undergone SSRF. The outcomes were post-procedural length of stay (LOS), hospital LOS, intensive care unit (ICU) LOS, in-hospital mortality, ventilator days, and tracheostomy rate. Multilevel mixed-effects regression analyses accounting for patient, injury, and hospital characteristics as well as institutional SSRF volume were used to assess the association between timing to SSRF and the outcomes of interest. As a sensitivity analysis, propensity-score matching was performed to compare patients who underwent early (<72 hours) versus late SSRF (≥72 hours). Of 1,041 patients included in this analysis, 430 (41.3%) underwent SSRF within the first 72 hours from admission. Delay to SSRF was associated with an increase in post-procedural LOS (partial regression coefficient (β) = 0.011; p = 0.036; 95% confidence interval [CI], 0.001-0.023), longer hospital LOS (β = 0.053; p < 0.001; 95% CI, 0.042-0.064), prolonged ICU LOS (β = 0.032; p < 0.001; 95% CI, 0.025-0.038), and more ventilator days (β = 0.026, p < 0.001; 95% CI, 0.020-0.032). In patients with concurrent multiple rib fractures and TBI, a delay in SSRF is associated with an increase in postprocedural LOS, hospital LOS, ICU LOS, and ventilator days. These findings suggest that the early patient selection and implementation of SSRF may play a beneficial role in patients presenting with concomitant TBI and multiple rib fractures. Therapeutic/Care Management; Level IV.

Early surgical stabilization of rib fractures for flail chest is associated with improved patient outcomes: An ACS-TQIP review.

Rib fractures are a common in thoracic trauma. Increasingly, patients with flail chest are being treated with surgical stabilization of rib fractures (SSRF). We performed a retrospective review of the Trauma Quality Improvement Program database to determine if there was a difference in outcomes between patients undergoing early SSRF (≤3 days) versus late SSRF (>3 days). Patients with flail chest in Trauma Quality Improvement Program were identified by CPT code, assessing those who underwent SSRF between 2017 and 2019. We excluded those younger than 18 years and Abbreviated Injury Scale head severity scores greater than 3. Patients were grouped based on SSRF before and after hospital Day 3. These patients were case matched based on age, Injury Severity Score, Abbreviated Injury Scale head and chest, body mass index, Glasgow Coma Scale, and five modified frailty index. All data were examined using χ2, one-way analysis of variance, and Fisher's exact test within SPSS version 28.0. For 3 years, 20,324 patients were noted to have flail chest, and 3,345 (16.46%) of these patients underwent SSRF. After case matching, 209 patients were found in each group. There were no significant differences between reported major comorbidities. Patients with early SSRF had fewer unplanned intubations (6.2% vs. 12.0%; p = 0.04), fewer median ventilator days (6 days Q1: 3 to Q3: 10.5 vs. 9 Q1: 4.25 to Q3: 14; p = 0.01), shorter intensive care unit length of stay (6 days Q1: 4 to Q3: 11 vs. 11 Q1: 6 to Q3: 17; p < 0.01), and hospital length of stay (15 days Q1: 11.75 to Q3: 22.25 vs. 20 Q1: 15.25 - Q3: 27, p < 0.01. Early plating was associated with lower rates of deep vein thrombosis and ventilator-acquired pneumonia. In trauma-accredited centers, patients with flail chest who underwent early SSRF (<3 days) had better outcomes, including fewer unplanned intubations, decreased ventilator days, shorter intensive care unit LOS and HLOS, and fewer DVTs, and ventilator-associated pneumonia. Therapeutic/Care Management; Level IV.

Continuous improvement in optimizing the timing of axial, hip, and femoral fracture fixation.

Benefits of early stabilization of femoral shaft fractures, in mitigation of pulmonary and other complications, have been recognized over the past decades. Investigation into the appropriate level of resuscitation, and other measures of readiness for definitive fixation, versus a damage control strategy have been ongoing. These principles are now being applied to fractures of the thoracolumbar spine, pelvis, and acetabulum. Systems of trauma care are evolving to encompass attention to expeditious and safe management of not only multiply injured patients with these major fractures, but also definitive care for hip and periprosthetic fractures, which pose a similar burden of patient recumbency until stabilized. Future directions regarding refinement of patient resuscitation, assessment, and treatment are anticipated, as is the potential for data sharing and registries in enhancing trauma system functionality.

Our experience with the results of surgical treatment of victims with concomitant injuries of the pelvis and femur

Hip fractures with damage to the pelvic bones are one of the most severe combined injuries of the musculoskeletal system. This article presents the results of our studies in 130 patients, which demonstrated that the active tactics of minimally invasive methods of treatment of femoral fractures combined with pelvic bone fractures looks quite reasonable. In favor of early stabilization of fractures, such strong arguments are put forward as the possibility of early activation of the patient, the prevention of threatening hypostatic complications. Combining the terms of consolidation and rehabilitation contributed to obtaining positive functional results, which significantly reduced the number of patients with severe consequences of injuries to the musculoskeletal system.

Geriatric Distal Femur Fracture Management Protocols: A Review and Evidence-based Template

Objectives: Provide a framework for the development of a “Code Femur” protocol for geriatric distal femur fractures.&#x0D; Design: Literature Review and Evidence Based Note Templates&#x0D; Intervention: Distal Femur Fracture Fixation and Medical Management&#x0D; Main Outcome Measurement: Post operative Mortality&#x0D; Results: Geriatric distal femur fractures are rising in number among osteoporotic fractures in the growing elderly population. Current hip fracture literature recommends fixation of proximal femur fractures in 24-48 hours to reduce mortality and the literature surrounding distal femur fractures in this population in trending in this direction as well. The goals of distal femur fracture surgery are early mobilization and fracture stabilization in addition to managing the multiple medical co-morbidities that these patients may have. This review discusses the treatment options available for geriatric distal femur fractures that allow for early mobilization and examines the benefits of early operative care.&#x0D; Conclusion: Geriatric Distal Femur Fractures present similar challenges to management as the geriatric hip fracture and a proper understanding of medical co-management and early appropriate surgery through the development of a distal femur fracture program similar to hip benefits warrants consideration.&#x0D; Level of Evidence: Level IV, Systematic Review&#x0D; Keywords: Code Femur, Geriatric, Distal Femur Fracture, Post-operative Mortality, Co-Morbidity

Rib Plating as an Effective Approach to Managing Traumatic Rib Injuries: A Review of the Literature.

Timely repair is essential to maximizing outcomes in patients with traumatic rib injuries, whether in the presence or absence of flail chest (FC) or existing as single or multiple rib fractures (MRF), due to its high morbidity and mortality rate. This review focuses primarily on the plating system as an effective surgical approach to stabilizing these injuries. Literature was surveyed using the Google Scholar, PLOS One, and PubMed search engines between August 2021 and April 2022. A total of 34 articles were included herein, and primary and secondary outcomes were assessed. The primary outcomes of interest were intensive care unit length-of-stay (ICU LOS), hospital length-of-stay (HLOS), ventilatory requirements, and mortality rate. The secondary outcomes of interest were postoperative pain level and postoperative complications. The majority of the studies included herein reported lower ICU LOS, HLOS, and ventilation requirements in surgical patients when compared to conservatively managed patients. However, variables such as the presence or absence of FC also impacted outcomes in certain studies. Mortality rate and postoperative pain were largely underreported in the selected studies, but limited data from these studies suggest that these outcomes tend to be lower in surgical patients compared to those treated conservatively. When present, postoperative complications were often less severe amongst surgical patients compared to conservatively managed patients. Results further suggest that surgical repair is associated with lower pain severity as early as 72 hours postop. Likewise, findings suggest that early rib fracture stabilization is superior to late stabilization and often yields a sooner return to a baseline health status. Few studies report little to no statistical difference in primary and secondary outcomes between operative and conservative treatment. However, there is greater evidence that suggests the contrary, with better short-term and potential for better long-term outcomes in patients who undergo rib fixation.

Subtrochanteric fractures

Subtrochanteric fractures represent adistinct entity. They are different from proximal femoral fractures as well as femoral shaft fractures. Nowadays, these fractures are mainly found in the geriatric population. Fractures in younger patients are indicative of high-energy trauma. Comorbidities are important in the geriatric population whereas accompanying injuries are most important in younger patients. Early surgical stabilization of subtrochanteric fractures is the treatment of choice, which under certain circumstances should also be carried out within the framework of damage control orthopedics. Long cephalomedullary nails represent the standard procedure. In geriatric patients the primary aim is weight bearing stability. The risk of complications with subtrochanteric fractures in the literature is relatively high. Classical compression plates play arole in the management of complications.

Extension-Distraction Spine Injury at Lumbosacral Junction: A Case Report

Case: We presented a case of extension-distraction spine injury at lumbosacral junction in a patient with fused spine concomitant with a lumbosacral transitional vertebra. Detail of an exceedingly rare case of traumatic lumbosacral hyperextension-distraction fracture in the individual was described and reviewed. Conclusion: Although the occurrence of extension-distraction spine injury at lumbosacral junction is extremely rare, it can occur in some circumstances. Application of damage control spine concept including early definitive stabilization of spine fractures and minimally invasive spine surgery can give satisfactory outcomes in the polytraumatized patient.

Possible advantages of early stabilization of spinal fractures in multiply injured patients with leading thoracic trauma\xa0- analysis based on the TraumaRegister DGU\xae

BackgroundMajor trauma often comprises fractures of the thoracolumbar spine and these are often accompanied by relevant thoracic trauma. Major complications can be ascribed to substantial simultaneous trauma to the chest and concomitant immobilization due to spinal instability, pain or neurological dysfunction, impairing the respiratory system individually and together. Thus, we proposed that an early stabilization of thoracolumbar spine fractures will result in significant benefits regarding respiratory organ function, multiple organ failure and length of ICU / hospital stay.MethodsPatients documented in the TraumaRegister DGU®, aged ≥16 years, ISS ≥ 16, AISThorax ≥ 3 with a concomitant thoracic and / or lumbar spine injury severity (AISSpine) ≥ 3 were analyzed. Penetrating injuries and severe injuries to head, abdomen or extremities (AIS ≥ 3) led to patient exclusion. Groups with fractures of the lumbar (LS) or thoracic spine (TS) were formed according to the severity of spinal trauma (AISspine): AISLS = 3, AISLS = 4–5, AISTS = 3 and AISTS = 4–5, respectively.Results1740 patients remained for analysis, with 1338 (76.9%) undergoing spinal surgery within their hospital stay. 976 (72.9%) had spine surgery within the first 72 h, 362 (27.1%) later on. Patients with injuries to the thoracic spine (AISTS = 3) or lumbar spine (AISLS = 3) significantly benefit from early surgical intervention concerning ventilation time (AISLS = 3 only), ARDS, multiple organ failure, sepsis rate (AISTS = 3 only), length of stay in the intensive care unit and length of hospital stay. In multiple injured patients with at least severe thoracic spine trauma (AISTS ≥ 4) early surgery showed a significantly shorter ventilation time, decreased sepsis rate as well as shorter time spend in the ICU and in hospital.ConclusionsMultiply injured patients with at least serious thoracic trauma (AISThorax ≥ 3) and accompanying spine trauma can significantly benefit from early spine stabilization within the first 72 h after hospital admission. Based on the presented data, primary spine surgery within 72 h for fracture stabilization in multiply injured patients with leading thoracic trauma, especially in patients suffering from fractures of the thoracic spine, seems to be beneficial.

Surgical Technique of Percutaneous Iliosacral Screw Fixation in S3 Level in Unstable Pelvic Fracture with Closed Degloving Injury and Morrell Lavallee Lesion: Two Case Reports

Unstable pelvic ring fractures raise treatment challenges in severely injured patients. Beside patient survival, demanding surgical technique also required. Classic technique of internal fixation requires extensive surgical exposure that leads to most complications of the pelvic fractures fixation. Therefore less invasive technique is a reasonable alternative especially in unstable pelvic fracture with soft tissue injury or potential infection. Unfortunately in sacral dysmorphism pelvic injury or in complete vertical sacral fracture, we need S3 level insertion to improve stability of iliosacral (IS) screw in S1 or S2. Purpose of this study was to show feasibility technically inserting IS screw in S3 level.Methods:We reported 2 cases of unstable pelvic injury. First case was an 11 years old boy with Torode and Zieg IV or Marvin Tile C1 pelvic fracture with right sacroiliac joint disruption and soft tissue injuries of skin avulsion on the left hip and Morel-Lavallée lesion on the right hip. He was managed with early anatomic reduction and fixation with percutaneous screws on both pubic rami and IS screw (sacroiliac lag screw type) on S1 and S3. Second case was a 30 years old male with open pelvic fracture Faringer zone III type, Marvin Tile B2 or YoungBurgess LC I and also with vertical sacral fracture Denis zone 1. This polytrauma case had associated injuries includes Morel-Lavallée lesion, intraperitoneal bladder rupture, infected laparotomy wound dehiscence, and immunocompromised. The same minimal invasive management of pelvic fracture was performed in this case by inserting percutaneous screws on pubic rami and IS (sacral screw type) on S1 and S3. Functional outcome was evaluated using Majeed and Hannover pelvic scoring system.Results:All patients survived and considered to have good reduction, with no residual displacement on the sacroiliac joint. The former case, at 21-month follow up, present with excellent outcome (80 out of 80) by Majeed score and very good outcome (4 out of 4) by Hannover score; while the latter case, at 18-month follow up, present with poor outcome (50 out of 100) by Majeed score and fair outcome (2 out of 4) by Hannover score.Conclusion:Percutaneous screw fixation for pelvic ring injury is a less invasive alternative that can be used for early stabilization of unstable anterior and posterior pelvic fractures and provide stable internal fixation. IS screw is feasible to be inserted in S3 level either sacroiliac joint type or sacral screw type.

A prospective study of functional outcome of distal femur fractures by locking plate

Introduction: In last few decades, rapid industrialization and the fast pace of life have brought both comforts and catastrophe like road traffic accidents and crippling many young lives. High velocity road traffic accidents are responsible for distal femur fractures more commonly observed in the young and middle aged patients. This necessitates early stabilization of fractures. Internal fixation is the choice of treatment in fractures distal femur and Locking Condylar plate has shown to give one of the best results in terms of recovery, fracture union, return to work and the functional outcome.Aims and objective: To study the outcome of open reduction and locking plate fixation of fractures of distal end of femur and to evaluate the effectiveness and complications of the Locking plate fixation method of treatment of fractures of distal end of femur.Material and Method: It is a prospective observational study. Conducted in patients admitted to Department of Orthopedics’ at BLDEU’S Shri B.M. Patil’s Medical College, Hospital and Research Centre, Vijayapura with diagnosis of distal Femur fracture. The patients were informed about study in all respects and informed written consent was obtained. Period of study was between November 2017 to May 2019. Follow up period was for 6 months. Data was analysed by SPSS v21 and p-value

Timing of Surgery in Thoracolumbar Spine Injury: Impact on Neurological Outcome.

Study Design:Retrospective cohort study.Objective:We aimed to evaluate the improvement in neurological deficit following early versus late decompression and stabilization of thoracolumbar junctional fractures.Methods:This is a retrospective evaluation of all patients with a traumatic spinal cord injury (SCI) from T11 to L2 treated at a teaching hospital between 2010 and 2017. Grouped analysis was performed comparing the cohort of patients who received early surgery within 24 hours (group 1) with those operated within 24 to 72 hours (group 2) and more than 72 hours after SCI (group 3). The primary outcome was the change in ASIA (American Spinal Injury Association) motor score at 12-month follow-up.Results:There were 317 patients (225 males and 92 females with mean age of 31.55 ± 12.43 years). A total of 144, 77, and 96 patients belonged to groups 1, 2, and 3 respectively. Improvement of at least 1 grade on ASIA classification was observed in 80, 45, and 33 patients in groups 1, 2, and 3 respectively (P = .001). Overall, 32, 12, and 10 patients improved ≥2 grades on ASIA classification in groups 1, 2, and 3, respectively (P = .069). On logistic regression analysis, early surgery and severity of initial injury (complete [ASIA A] vs incomplete SCI [ASIA B-D]) were found to significantly influence the potential for neurologic improvement (P = .004 and P < .0001, respectively).Conclusion:We believe that the earlier the decompression, the better. The 72-hour cutoff represents the most promising time window during which surgical decompression has the potential to confer a neuroprotective effect in the setting of incomplete SCI (ASIA B-D) in the distal region of the spinal cord (conus medullaris).

A clinical study of surgical management of distal femur fracture using locking compression plate

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Fractures of distal femur are common due to increased road traffic accidents and fall from height because of increased construction activities. These fractures are quite disabling hence, these fractures necessitate early stabilization of fractures. Internal fixation with LCP has shown to give one of the best results in terms of recovery, fracture union, and clinical outcome. The aim of the study the clinical outcome of treatment of distal femur fractures using locking compression plates.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A total of n=20 cases of distal femur fractures treated with LCP from December 2013 to June 2015 at NMCH and RC, Raichur. They were admitted and examined according to protocol clinically and radiologically. All patients were followed up for a minimum of 6 months and outcome assessed with Neer’s score.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; All fractures healed with an average duration of 16 weeks which is comparable with other studies. We had two cases of varus collapse one was due to early weight bearing in one case and other case is due to gross communition. One case had an implant failure (plate breakage) due to early weight bearing. Cases needing hardware revision is comparable to other studies at 10%. Average Neer's knee score was 76.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; we have found higher Neer’s scores in this study. The LCP also prevents compression of periosteal vessels. It may not completely solve the age-old problems associated with any fracture like non-union and malunion, but is a valuable technique in the management of these fractures. But however, in type C fractures the outcome is poorer.&lt;/p&gt;

Minimally invasive plate osteosynthesis of distal end femur using locking compression plate

Background:Fractures distal femur are one of the commonest fractures encountered in high velocity trauma which are associated with high morbidity and mortality. Isolated fracture can itself lead to complications such as pulmonary embolism. This necessitates early stabilization of fractures. Internal fixation is the choice of treatment in fractures distal femur with LCP. Plate has shown to give one of the best results in terms of recovery, fracture union, return to work and the functional outcome. Objectives: To study the functional results of fracture distal femur treated closed reduction with locking compression plate by Minimally Invasive Percutaneous Plate Osteosynthesis.Methods: 20 cases of fracture distal end femur were treated by closed reduction and internal fixation with LCP by MIPPO. The patients were evaluated clinically and radiologically for outcomes. All patients were followed up for an average of 12 months. Outcome was assessed using NEER’S Score.Results: In our study 22 distal femoral fractures were treated. All cases were fresh, 19 patients were males and 3 patients were females. The median age was 45 years ranging from 22-68 years? 16 of the fractures were caused by road traffic accidents and 5 were due to fall, 2 were due to assault. 14 patients were with fracture on right side and 6 on left side. Using Neers scoring system excellent is 54%, good is 28%, and fair is 22%. Range of motion of knee & Hip was excellent to very good. Gait and weight bearing after complete union was satisfactory.Conclusion: Closed reduction and internal fixation of fracture lower end of femur using locking compression plate by minimally invasive plate osteosynthesis is one of the best modalities of treatment especially in intraarticular fractures where the maintenance of articular congruity is crucial. Fixation with locking condylar plate showed more effectiveness in severly osteopototic bones, shorter post-operative stay, faster recovery, earlier union rates and excellent functional outcome compared to alternative procedures in other studies.

Fat Embolism and Fat Embolism Syndrome.

Fat embolism (FE) occurs frequently after trauma and during orthopaedic procedures involving manipulation of intramedullary contents. Classically characterized as a triad of pulmonary distress, neurologic symptoms, and petechial rash, the clinical entity of FE syndrome is much less common. Both mechanical and biochemical pathophysiologic theories have been proposed with contributions of vascular obstruction and the inflammatory response to embolized fat and trauma. Recent studies have described the relationship of embolized marrow fat with deep venous thrombosis and postsurgical cognitive decline, but without clear treatment strategies. Because treatment is primarily supportive, our focus must be on prevention. In trauma, early fracture stabilization decreases the rate of FE syndrome; however, questions remain regarding the effect of reaming and management of bilateral femur fractures. In arthroplasty, computer navigation and alternative cementation techniques decrease fat embolization, although the clinical implications of these techniques are currently unclear, illustrating the need for ongoing education and research with an aim toward prevention.

Team Approach: Timing of Operative Intervention in Multiply-Injured Patients.

* Patients with multiple-system trauma are best managed by a multidisciplinary team.* The general trauma surgeon is the leader of the care team, facilitating expeditious evaluation, resuscitation, and other treatment.* Early Appropriate Care is the definitive treatment of mechanically unstable fractures of the thoracolumbar spine, pelvis, acetabulum, and proximal and diaphyseal regions of the femur once the patient is adequately resuscitated as indicated by improvement of metabolic acidosis (at least 1 of the following findings: lactate &lt;4.0 mmol/L, pH ≥7.25, or base excess ≥−5.5 mmol/L).* Early definitive stabilization of major axial and femoral fractures reduces complications, the duration of the hospital stay, and costs.

Fat Embolism Syndrome Due to Fracture Right Femur : A Case Report

Fat embolism syndrome (FES) is usually associated with fractures of long bones and pelvis. Symptoms usually occurs hours to days after injury. We present a case with fat embolism syndrome due to fracture femur. Prompt supportive treatment of patient's respiratory system and additional pharmaceutical treatment provides the positive outcome. There is no specific therapy for fat embolism syndrome. Prevention, early diagnosis, and adequate symptomatic treatment are very important. The incidence of fat embolism syndrome is reduced markedly in last decades due to early stabilization and surgical correction of fractures of long bones.