Journal
JOURNAL OF ORTHOPAEDIC TRAUMA
Volume 30, Issue 3, Pages 104-112Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/BOT.0000000000000489
Keywords
multiple trauma; fracture healing; primary fracture stabilization
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Objective: This review aims to summarize current knowledge regarding the underlying patho-mechanisms of delayed fracture healing in polytraumatized patients. Data Sources and Study Selection: The following search terms were used: fracture, hemorrhage, chest trauma, inflammation, inflammatory response, fracture healing, delayed healing, nonunion, fracture stabilisation, intramedullary nailing, external fixation, early total care, and damage control. Medline, Embase, and Cochrane Library were searched for studies published between January 1, 1990 through March 30, 2014. Of 1322 publications, 68 were included in the current summary. Conclusion: Concomitant injuries and the strategy for fracture stabilization seem to affect bone metabolism and fracture healing. Among the relevant patho-mechanisms, interactions between the local and systemic inflammatory response seem to play a role. However, the consequences of fracture fixation strategies in case of severe concomitant injuries on local inflammation and bone healing remain unknown. Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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