Traduci: Polytraumatic conditions are frequently life-threatening situa- tions that require a special approach. The principles of fracture management in patients with multiple injuries, including head, chest, abdominal or pelvic injuries with blood loss, continue to be of crucial importance. The management of severely injured patient with fractures has changed over the last decades. In the early 70s long bone fractures were mainly stabilized by traction.1 This concept was associated with numerous complications such as pulmonary infections, atrophy of the musculature and thrombo- embolic complications due to prolonged immobilization.2 
Polytraumatic conditions are frequently life-threatening situa- tions that require a special approach. The principles of fracture management in patients with multiple injuries, including head, chest, abdominal or pelvic injuries with blood loss, continue to be of crucial importance. The management of severely injured patient with fractures has changed over the last decades. In the early 70s long bone fractures were mainly stabilized by traction.1 This concept was associated with numerous complications such as pulmonary infections, atrophy of the musculature and thrombo- embolic complications due to prolonged immobilization.2 
Bone and coauthors published a prospective randomized study including 178 multiply injured (ISS > 18) patients and compared the clinical outcome after early (<24 h) and delayed (>48 h) femoral fracture fixation.1 In this marked publication early total care (ETC) strategy has been associated with less pulmonary com- plications and reduced length of stay on intensive care unit and hospital. Early fracture fixation resulted in early mobilization, avoided nutritional depletion and long drug therapy and reduced wound infections.3,4 Thus, ETC has become a standard approach in polytrauma in the 80s and early 90s. This strategy was further stimulated by advances of osteosynthesis techniques and implants over these decades. 
Several authors, however; criticized that early fixation might be detrimental for several patient groups.5,6 This method of combined surgical procedures may lead to development of an additional, secondary life-threatening inflammatory response reaction, which can cause an excessive inflammatory reaction known as the “sec- ondary hit".7e10 ETC in unstable poly-traumatized patients may significantly increase the severity of this systemic inflammatory response (SIRS) and may lead to development of acute respiratory distress syndrome (ARDS) and multiple organ failure (MOF), car- rying a relatively high incidence of morbidity and mortality.5,11,12