Today, we take for granted that fixing fractures early is a good thing. However, this topic was still under debate 20 years ago. Trauma care has always been prioritized, with life-threatening injuries taking precedence. It was very common for major trauma patients to undergo operation for their torso injuries, and then be deemed “too unstable” to undergo repair of their extremities.
Weigelt et al reported decreased pulmonary complications with early fixation in 1989. A study published in July 1990 looked at 121 early vs 218 late femur fixations with respect to more concrete outcomes. The patients were similar with respect to hypotension, transfusions and associated injuries.
They found that delayed fixation increased pulmonary shunt, especially in patients with more severe injuries, and increased the incidence of pneumonia in older patients. It also resulted in more ICU days and a significantly longer hospital stay in the more severely injured group.
This paper was a valuable addition that began to shape our appreciation for the importance of early fixation of most fractures. Major trauma makes patients sick, but they are in the best condition they will be in for weeks at the time they arrive at the hospital. This makes it the ideal time to take care of injuries that may otherwise contribute to morbidity and mortality.
Reference: Fabian et al. Improved outcome with femur fractures: early vs delayed fixation. J Trauma 30(7):792, 1990.