title: Advances and future directions for management of trauma patients with musculoskeletal injuries.
abstract: Musculoskeletal injuries are the most common reason for operative procedures in severely injured patients and are major determinants of functional outcomes. In this paper, we summarise advances and future directions for management of multiply injured patients with major musculoskeletal trauma. Improved understanding of fracture healing has created new possibilities for management of particularly challenging problems, such as delayed union and non union of fractures and large bone defects. Optimum timing of major orthopaedic interventions is guided by increased knowledge about the immune response after injury. Individual treatment should be guided by trading off the benefits of early definitive skeletal stabilisation, and the potentially life-threatening risks of systemic complications such as fat embolism, acute lung injury, and multiple organ failure. New methods for measurement of fracture healing and function and quality of life outcomes pave the way for landmark trials that will guide the future management of musculoskeletal injuries.
authors.affiliation: Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia. zsolt.balogh@hnehealth.nsw.gov.au
authors.forename: Zsolt J
authors.initials: ZJ
authors.lastname: Balogh
authors.forename: Marie K
authors.initials: MK
authors.lastname: Reumann
authors.forename: Russell L
authors.initials: RL
authors.lastname: Gruen
authors.forename: Philipp
authors.initials: P
authors.lastname: Mayer-Kuckuk
authors.forename: Michael A
authors.initials: MA
authors.lastname: Schuetz
authors.forename: Ian A
authors.initials: IA
authors.lastname: Harris
authors.forename: Belinda J
authors.initials: BJ
authors.lastname: Gabbe
authors.forename: Mohit
authors.initials: M
authors.lastname: Bhandari
mesh_terms: D035843:Biomedical Research / Q000639:trends; D019317:Evidence-Based Medicine; D005592:Fracture Fixation / Q000379:methods / Q000639:trends; D017102:Fracture Healing; D006801:Humans; D009104:Multiple Trauma / Q000601:surgery; D009141:Musculoskeletal System / Q000293:injuries*; D019637:Orthopedic Procedures / Q000379:methods / Q000639:trends*; D018746:Systemic Inflammatory Response Syndrome / Q000503:physiopathology; D016896:Treatment Outcome