Balogh, Zsolt J.Reumann, Marie K.Gruen, Russell L.Mayer-Kuckuk, PhilippSchuetz, Michael A.Harris, Ian A.Gabbe, Belinda J.Bhandari, Mohit2025-06-302025-06-300140-6736PubMed:22998720ORCID:/0000-0001-8023-1957/work/162949569http://www.scopus.com/inward/record.url?scp=84866481230&partnerID=8YFLogxKhttps://hdl.handle.net/1885/733765583Musculoskeletal injuries are the most common reason for operative procedures in severely injured patients and are major determinants of functional outcomes. In this paper, we summarise advances and future directions for management of multiply injured patients with major musculoskeletal trauma. Improved understanding of fracture healing has created new possibilities for management of particularly challenging problems, such as delayed union and non union of fractures and large bone defects. Optimum timing of major orthopaedic interventions is guided by increased knowledge about the immune response after injury. Individual treatment should be guided by trading off the benefits of early definitive skeletal stabilisation, and the potentially life-threatening risks of systemic complications such as fat embolism, acute lung injury, and multiple organ failure. New methods for measurement of fracture healing and function and quality of life outcomes pave the way for landmark trials that will guide the future management of musculoskeletal injuries.We thank the Victorian State Trauma Registry and the Victorian Orthopaedic Trauma Outcomes Registry for the original data presented in the introduction and outcomes sections; Susan Liew, Adele Boskey, Jeffrey Rosenfeld, Peter Bragge, and Nerida Butcher for critical reading of the manuscript; Ornella Clavisi, Loretta Piccenna, and Manda Kaled for article searches and retrieval; and Sarah Aird for copy editing the manuscript. RG is supported by a Practitioner Fellowship from the Australian National Health and Medical Research Council.11en201210.1016/S0140-6736(12)60991-X84866481230