In recent years, several treatment strategies for fracture fixation have been introduced, including the concept of safe definitive surgery (SDS), early appropriate care (EAC) or prompt individualized and safe management (PRISM). These concepts appear to be based on regional specifics and showed apparent controversies.
It is understood that all these concepts aim to optimize the timing of surgical treatment in patients with musculoskeletal injuries based on the assessment of the patient's physiology. In addition to physiological parameters, concomitant injuries also play a crucial role in decision-making. As the indications for damage control (severe chest trauma, unstable patients, borderline patients that do not respond to resuscitation) do not have to be discussed any more, it appeared to be necessary to have a consensus beyond geographical peculiarities.
Therefore, an international multidisciplinary consensus panel on polytrauma has met several times in order to develop this consensus on the basis of a Delphi process. It focuses on the timing of fracture fixation in patients with concomitant traumatic brain, thoracic, abdominal, spinal/spinal cord and vascular injuries.
The international multidisciplinary group (Table 1) includes experts from various countries – and in all fields involved in the care of severely injured patients (trauma surgeons, orthopedic surgeons, general surgeons, anesthesiologists and neurosurgeons).
Table 1: List of international experts, participating in the consensus process
In spring 2023, the organizing committee drafted 12 statements defining the conditions under which fracture fixation can be performed in polytrauma patients with concomitant brain, chest, abdominal, spinal and vascular injuries. These 12 statements were sent twice to the members of the consensus group and repeatedly updated based on the comments received. The final consensus meeting took place from September 13 to 14, 2023 at the University Hospital Zurich. A total of 17 committee members from around the world actively discussed all statements based on the existing literature and adjusted the statements until the greatest possible agreement was reached. An anonymous vote was performed for each statement. At the end of the consensus meeting, the trauma group reviewed 20 statements (Table 2) and 74 publications. Consensus was reached on all 20 statements. An agreement of ≥ 75% was defined as the threshold for consensus. The results of the meeting will be published in surgical, orthopedic and traumatology journals. The published recommendations will be summarized later in SWISS KNIFE.
| Agreed statements | |
| TBI | 5 statements with agreement >94% |
| Thoracic Trauma | 3 statements with agreement >94% |
| Abdominal Trauma | 4 statements with agreement >94% |
| Multiple Fractures | 3 statements with agreement 100% |
| Spinal Injury | 3 statements with agreement >92% |
| Vascular Injury | 2 statements with agreement 100% |
