Key messages
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Orthopaedic injuries are major determinants of resource use and long-term outcomes in multiply injured patients
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Traumatic and surgical tissue injury drives the inflammatory response through endogenous danger molecules, even without haemorrhagic shock or infection
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Individually tailored timing of major fracture fixation can maximise the benefits of timely skeletal stabilisation and minimise the risks of systemic complications
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Increased understanding of the effects of systemic inflammation on fracture healing is needed
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Biological enhancements of fracture healing that are in development could be of particular benefit for large bone defects
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The evolving definition of fracture healing will provide better endpoints for future trials
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Patient-centred outcome measures show that patients have substantial long-term disability after major orthopaedic injury, and such measures should be included in clinical trials
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Comparative effectiveness research is needed to define the benefits of modern implants on patient outcomes