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Peer-reviewedCC BY-NC-NDOTA international : the open access journal of orthopaedic trauma

Basic science and surgical timing for polytrauma patients.

  • Emily Pedrick1
  • Roman Pfeifer2
  • Emil Schemitsch3
  • Michel Teuben4
  • Heather Vallier5
  • Justin Haller1
  • Hans-Christoph Pape2
5 affiliations
  1. 1Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT.
  2. 2Department of Trauma Surgery, University Hospital Zürich, Zürich, Switzerland.
  3. 3Department of Surgery, Western University, London Health Sciences Centre, University Hospital, London, ON, Canada.
  4. 4Department of Traumatology, University Hospital Zürich, Zürich, Switzerland.
  5. 5Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH.
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Abstract

Polytrauma patients are a challenging cohort to treat because their multiple, potentially life-threatening injuries act synergistically with surgeries to affect cellular pathways necessary for survival. Current treatment algorithms and blood tests often fail to predict which patients will tolerate early fracture fixation and which patients will continue to deteriorate because of their injuries. Traditional laboratory tests in polytrauma patients have not been able to capture the nuances of cellular energy depletion, and lipidomics are now emerging as potential biomarkers to better categorize disease severity. Definitive treatment of fractures in polytrauma patients within 36 hours is recommended, but there is little consensus on the parameters necessitating "damage control" strategies. The IMPACT group recommends fixation within 24 hours and a dynamic treatment strategy rather than strict guideline adherence. In particular, patients with moderate to severe traumatic brain injury require cautious, individualized decision-making given their neurologic risks. The purpose of this review is to describe emerging diagnostic tools and treatment algorithms that are shifting the management of polytrauma patients from rigid protocols towards dynamic, individualized assessments.

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Cite

BibTeXRIS
BibTeX
@article{pedrick2026basic,
  title = {{Basic science and surgical timing for polytrauma patients.}},
  author = {Emily Pedrick and Roman Pfeifer and Emil Schemitsch and Michel Teuben and Heather Vallier and Justin Haller and Hans-Christoph Pape},
  journal = {OTA international : the open access journal of orthopaedic trauma},
  year = {2026},
  month = oct,
  doi = {10.1097/oi9.0000000000000517},
  url = {https://europepmc.org/article/MED/42953681},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Basic science and surgical timing for polytrauma patients.
AU  - Emily Pedrick
AU  - Roman Pfeifer
AU  - Emil Schemitsch
AU  - Michel Teuben
AU  - Heather Vallier
AU  - Justin Haller
AU  - Hans-Christoph Pape
PY  - 2026
DA  - 2026/10/23
JO  - OTA international : the open access journal of orthopaedic trauma
DO  - 10.1097/oi9.0000000000000517
UR  - https://europepmc.org/article/MED/42953681
AB  - Polytrauma patients are a challenging cohort to treat because their multiple, potentially life-threatening injuries act synergistically with surgeries to affect cellular pathways necessary for survival. Current treatment algorithms and blood tests often fail to predict which patients will tolerate early fracture fixation and which patients will continue to deteriorate because of their injuries. Traditional laboratory tests in polytrauma patients have not been able to capture the nuances of cellular energy depletion, and lipidomics are now emerging as potential biomarkers to better categorize disease severity. Definitive treatment of fractures in polytrauma patients within 36 hours is recommended, but there is little consensus on the parameters necessitating "damage control" strategies. The IMPACT group recommends fixation within 24 hours and a dynamic treatment strategy rather than strict guideline adherence. In particular, patients with moderate to severe traumatic brain injury require cautious, individualized decision-making given their neurologic risks. The purpose of this review is to describe emerging diagnostic tools and treatment algorithms that are shifting the management of polytrauma patients from rigid protocols towards dynamic, individualized assessments.
SN  - 2574-2167
ER  -