Excerpt from JOURNAL OF TRAUMA 2001;50:958-967

Practice Management Guidelines for the Optimal Timing of Long-Bone Fracture Stabilization in Polytrauma Patients: The EAST Practice Management Guidelines Work Group

C.Michael Dunham, MD; Michael J. Bosse, MD; Thomas V. Clancy, MD; Frederic J. Cole Jr., MD; Maxime J. M. Coles, MD; Thomas Knuth, MD; Fred A. Luchette, MD; Robert Ostrum, MD; Brian Plaisier, MD; Attila Poka, MD; Ronald J. Simon, MD

B. Quality of the References

The quality assessment instrument applied to the references was developed by the EAST Practice Management Guidelines Committee. Articles were classified as Class I, II, or III according to the following definitions:

Class I: A randomized clinical trial. There were no Class I articles identified.
Class II: A prospective, noncomparative clinical study or a retrospective analysis derived from reliable data.
Class III: A retrospective case series or database review.

III. RECOMMENDATIONS

A. Level I

Definition: This recommendation is convincingly justifiable on the basis of the available scientific information alone. It is usually derived from Class I data; however, strong Class II evidence may form the basis for a Level I recommendation. There is insufficient evidence to support a standard of care on this topic.

B. Level II

Definition: This recommendation is reasonably justifiable by available scientific evidence. It is usually supported by Class II data or a preponderance of Class III evidence.

1. Polytrauma patients undergoing long-bone stabilization within 48 hours of injury have no improvement in survival when compared with those receiving later stabilization; however, there may be some patients who will have fewer complications. There is no evidence that early stabilization has any detrimental effect. It is preferable to perform early long-bone stabilization in polytrauma patients.
2. There is no compelling evidence that early long-bone stabilization in mild, moderate, or severe brain injured patients either enhances or worsens outcome. The timing of long-bone stabilization should be individualized according to the patient's clinical condition.
3. There is no compelling evidence that early long-bone stabilization in patients with chest injury alters outcome. The timing of long-bone stabilization should be individualized according to the patient's clinical condition.