Current Strategies in the Management of Complicated Fractures

The treatment paradigm for complex fractures has transformed into a multidisciplinary framework that integrates mechanical stability, soft-tissue preservation, and patient-specific optimization. High-energy injuries frequently complicate management due to extensive comminution, significant soft-tissue compromise, and an elevated risk of infection. Contemporary strategies emphasize biological osteosynthesis and minimally invasive fixation techniques, aiming to preserve vascularity, minimize iatrogenic trauma, and enhance the intrinsic healing environment. The incorporation of digital technologies – including preoperative three-dimensional (3D) planning, patient-specific implants, and computer-assisted reduction – has further refined surgical precision, improving reduction quality and reducing operative morbidity. Infection prevention remains a central priority in the management of these injuries. Early antibiotic prophylaxis, timely and thorough debridement, and coordinated orthoplastic collaboration substantially reduce postoperative complications. Standardized diagnostic criteria and structured multidisciplinary team (MDT) decision-making are essential components in the treatment of fracture-related infection. Moreover, orthobiologic interventions such as mesenchymal stem cells, platelet-rich plasma, and bone morphogenetic proteins have expanded therapeutic options, particularly in challenging cases of delayed union and nonunion, by enhancing the biological potential for regeneration. In geriatric patients, individualized care pathways incorporating metabolic optimization, principles of fragility fracture management, and orthogeriatric co-management have been shown to reduce complications and facilitate early mobilization. Overall, the modern approach to complex fractures is defined by the integration of biology, biomechanics, and clinical reasoning. This chapter provides a comprehensive and up-to-date overview of these evolving concepts, highlighting the ongoing shift toward personalized, biologically attuned, and multidisciplinary trauma care.