The management of the polytraumatized orthopedic patient remains a challenging issue. In recent years many efforts have been made to develop rescue techniques and to promote guidelines for the management of these patients. Currently controversies persist between two orthopedic approaches: the Early Total Care and the Damage Control Orthopedics. An overview of the current literature on the orthopedic management of polytrauma patient is provided. Subsequently, femoral shaft fractures, representing extremely common lesions, and pelvic ring injuries, that are associated with a high mortality rate, are analyzed in detail. 1. Introduction The term “polytrauma” is mainly used to describe blunt trauma patients whose injuries involve multiple body regions or cavities, compromise patient’s physiology, and potentially cause dysfunction of uninjured organs [1]. Polytrauma is one of the main causes of death in the world. Since young people are frequently involved, trauma is the leading cause of death under the age of 40 [2]. Fractures are frequently components of polytrauma patterns. These lesions must be considered as wounds of bone and soft tissue, giving rise to stress, pain, and hemorrhage. They can be contaminated and cause compartment syndromes with ischemia-reperfusion injury [3]. Patients are at risk of higher morbidity and mortality than the summation of expected morbidity and mortality of each individual injury. Although polytrauma patients represent a major therapeutic challenge, improved results can be achieved in dedicated institutions with efficient triage and focused trauma specialist care. The treatment of polytrauma patients noted a significant development as a result of better understanding of the physiopathological mechanisms of injury, development of a network of prehospital trauma management, institution of multispecialist integrated groups, and improved intensive care resuscitation. The ideal approach to orthopedic injuries is to perform definitive fixation of all fractures in one trip to the operating room. This approach, called Early Total Care (ETC), was widely used in the 80’s; not only does it allow the most efficient employment of the operating room and orthopedic surgeons, but also permits patients to be promptly mobilized for tests and therapies [4]. However, there are several scenarios in which immediate definitive fixation of all fractures is not feasible because of patient instability, preventing lengthy operation with associated blood loss. These patients have a primary indication for Damage Control Orthopedics (DCO), a procedure
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