Fracture Fixation Sequencing in Polyskeletal Trauma: Clinical Experience from a Five-Patient Retrospective Series.

Aims and Background: Polyskeletal trauma involving multiple long-bone fractures presents major challenges in deciding the sequence and timing of fracture fixation. While early total care may benefit physiologically stable patients, staged management based on damage control orthopedics is often safer in complex trauma. Evidence guiding fracture sequencing remains limited. This study reviews five patients managed using individualized staged fixation strategies. Materials and Methods: A retrospective case series was conducted at a tertiary trauma center after institutional ethics committee approval (IEC Ref: CSP-MED/26/FEB/126/62; dated February 27, 2026). Five adult patients with fractures involving two or more long bones were included. Data were collected from case records, operative notes, and radiographs. Variables analyzed included injury pattern, associated injuries, temporary stabilization, timing of definitive fixation, fixation sequence, and early outcomes. Results: All patients initially underwent damage control stabilization using external fixation or splintage where indicated. Definitive fixation was performed in stages after physiological optimization. Pelvic instability, pulmonary injury, cardiac contusion, metabolic comorbidity, soft-tissue compromise, and operative positioning influenced sequencing decisions. All patients achieved fracture stabilization without major early implant-related complications. Conclusion: Fracture sequencing in polyskeletal trauma should be individualized rather than protocol-driven. A staged approach guided by damage control orthopedic principles allows safe definitive fixation while minimizing systemic stress.