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Is There an Impact of Concomitant Injuries and Timing of Fixation of Major Fractures on Fracture Healing? A Focused Review of Clinical and Experimental Evidence

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.