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Orthopaedic traumatology: fundamental principles and current controversies for the acute care surgeon
  1. Shad K Pharaon1,
  2. Shawn Schoch2,
  3. Lucas Marchand3,
  4. Amer Mirza4,
  5. John Mayberry5,6
  1. 1 Trauma and Acute Care Surgery, PeaceHealth Southwest Medical Center, Vancouver, Washington, USA
  2. 2 Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington, USA
  3. 3 Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USA
  4. 4 Orthopaedic Trauma Surgery, Legacy Emanuel Medical Center, Portland, Oregon, USA
  5. 5 Trauma and Acute Care Surgery, Saint Alphonsus Regional Medical Center, Boise, Idaho, USA
  6. 6 Department of Surgery, WWAMI Regional Medical Education, University of Washington School of Medicine, Seattle, Washington, USA
  1. Correspondence to Dr John Mayberry, Department of Trauma and Acute Care Surgery, Saint Alphonsus Health System, Boise, Idaho, USA; john.mayberry{at}


Multiply injured patients with fractures are co-managed by acute care surgeons and orthopaedic surgeons. In most centers, orthopaedic surgeons definitively manage fractures, but preliminary management, including washouts, splinting, reductions, and external fixations, may be performed by selected acute care surgeons. The acute care surgeon should have a working knowledge of orthopaedic terminology to communicate with colleagues effectively. They should have an understanding of the composition of bone, periosteum, and cartilage, and their reaction when there is an injury. Fractures are usually fixed urgently, but some multiply injured patients are better served with a damage control strategy. Extremity compartment syndrome should be suspected in all critically injured patients with or without fractures and a low threshold for compartment pressure measurements or empiric fasciotomy maintained. Acute care surgeons performing rib fracture fixation and other chest wall injury reconstructions should follow the principles of open fracture reduction and stabilization.

  • acute care surgery
  • fracture healing
  • bone graft
  • compartment syndrome

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  • Contributors All authors contributed equally to the creation and revisions of the manuscript.

  • Competing interests JM accepts honoraria for speaking and consulting fees from Acute Innovations, Hillsboro, Oregon, USA. Other authors have no competing interests to declare.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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