Treatment Guidelines for Orthopedic Injuries

Original Date: 07/2022
Purpose: To standardize treatment of orthopedic injuries.

Type and severity of acetabular fractures that will be treated versus transferred

All acetabular and pelvic fractures will be treated at our institution.

  • Exception:  Hemodynamically stable patients requiring joint replacement may be transferred to a Memorial Hermann Joint center after clearance by orthopedic surgery and ED physician or trauma surgeon.

Timing and sequence for the treatment of long bone fractures in multiply injured patients:

  • Hemodynamically stable patients
    • definitive fixation/reduction/splinting within 24 hours of clearance by the trauma team
  • Hemodynamically unstable patients
    • external fixation/reduction/splinting at first OR visit or once cleared by the trauma team
    • temporary splinting for all fractures in the Emergency Department

Open extremity fractures

I&D of fractures with definitive fixation/external fixation/reduction and splinting within 24 hours of admission

Antibiotics will be administered within 60 minutes of arrival to the ED if not already given prior to arrival.  Please refer to the Antibiotic Therapy guideline for further details.

Time to wound coverage: 

Timing of definitive soft tissue coverage will vary per patient based on complexity of wound and burden of other traumatic injuries but should occur within 7 days (more simple wounds) to 30 days (complex microvascular free flaps) with some clinical exceptions.

Hip fractures in geriatric patients

Operative fixation of hip fractures in geriatric patients within 24 hours of admission pending cardiac clearance in select cases.

Patients with hemodynamically instability secondary to pelvic ring injuries

Please refer to “Management of Hemodynamically Significant Pelvic Fractures” protocol.