Evidence map›Paper›PMID 39827327›Full record

SynthesisEuropean journal of trauma and emergency surgery : official publication of the European Trauma Society2025

Optimal timing of stabilization and operative technique for extremity fractures in polytrauma patients: a systematic review and meta-analysis.

Eva Steinfeld, Klemens Horst, Kelly Ansems, Karolina Dahms, Julia Dormann, Heidrun Janka, Maria Inti-Metzendorf, Carina Benstoem, Frank Hildebrand, Nils Becker

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in European journal of trauma and emergency surgery : official publication of the European Trauma Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Early versus delayed fixation of maxillofacial fractures in polytrauma: a systematic review.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2026
    Pooled it
  2. Article
  3. Timing of fracture fixation for femur and pelvis fractures in patients with severe traumatic brain injury - an analysis of the TraumaRegister DGUEuropean journal of trauma and emergency surgery : official publication of the European Trauma Society · 2026
    Article
  4. Review
  5. Review
  6. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Eva SteinfeldDepartment of Intensive Care Medicine and Intermediate Care, Medical Faculty, RWTH Aachen University, Aachen, Germany.
Klemens HorstDepartment of Orthopaedics, Trauma and Reconstructive Surgery, Medical Faculty, RWTH Aachen University, Aachen, Germany.
Kelly AnsemsDepartment of Intensive Care Medicine and Intermediate Care, Medical Faculty, RWTH Aachen University, Aachen, Germany.
Karolina DahmsDepartment of Intensive Care Medicine and Intermediate Care, Medical Faculty, RWTH Aachen University, Aachen, Germany.
Julia DormannDepartment of Intensive Care Medicine and Intermediate Care, Medical Faculty, RWTH Aachen University, Aachen, Germany.
Heidrun JankaInstitute of General Practice, Medical Faculty, Heinrich-Heine-University Dusseldorf, Dusseldorf, Germany.
Maria Inti-MetzendorfInstitute of General Practice, Medical Faculty, Heinrich-Heine-University Dusseldorf, Dusseldorf, Germany.
Carina BenstoemDepartment of Intensive Care Medicine and Intermediate Care, Medical Faculty, RWTH Aachen University, Aachen, Germany.
Frank HildebrandDepartment of Orthopaedics, Trauma and Reconstructive Surgery, Medical Faculty, RWTH Aachen University, Aachen, Germany.
Nils BeckerDepartment of Orthopaedics, Trauma and Reconstructive Surgery, Medical Faculty, RWTH Aachen University, Aachen, Germany. nils.becker@uniklinik-ulm.de.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeIn polytrauma patients, injuries involving the extremities are frequently seen. Treatment concepts vary from early definitive care to temporary fixation and delayed definite stabilization. This analysis therefor aims to illuminate the impact of timing for operative stabilization of extremity fractures on outcome factors in adult polytrauma patients.

methodsWe searched PubMed and Cochrane CENTRAL to identify studies from inception of each database to 14 September 2022. We included systematic reviews and RCTs comparing immediate versus delayed operative fracture stabilization and early definite care versus primary external fixation in adult polytrauma patients.

resultsFive randomized controlled trials were included, with a total of 335 patients. The analysis found no statistically significant difference in overall mortality or improvement in ICU admission between early (< 24 h) and late fracture stabilization. Comparing femoral nailing and external fixation, findings showed that femoral nailing reduce ICU length of stay and duration of invasive mechanical ventilation.

conclusionThe results indicate that immediate surgical treatment by nailing is superior to delayed treatment or a staged surgical approach in stable polytrauma patients with long-bone fractures. As there is a lack of clear evidence regarding the optimal timing for definitive operative stabilization of extremity fractures in polytrauma patients, further high-quality studies are essential to enhance the certainty of evidence and provide more conclusive treatment algorithms.

Indexed as

ExtremitiesFracture FixationFractures, BoneMultiple TraumaTime-to-TreatmentHumansLength of StayRandomized Controlled Trials as TopicTime FactorsDamage-control-orthopedics (DCO)Early total care (ETC)Extremity fracturesIntensive carePolytrauma

Identifiers

PMID39827327
PMCPMC11742870

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.