Nutritional Resuscitation in Patients With Orthopaedic Trauma: A Guide for the Practicing Orthopaedic Surgeon
Abstract
» Postoperative nutritional optimization is an important, evidence-based intervention in trauma fracture care. Trauma induces a sustained hypermetabolic-catabolic response that overlaps with the critical phases of fracture healing, making early (within 24-48 hours) and structured nutritional intervention an opportunity for improvement in standard care. » A 12-week supplementation protocol is suggested for patients with operatively treated fractures. High-protein supplementation (1.5-2.0 g/kg/d for body mass index [BMI] <30; adjusted body weight-based dosing for BMI ≥30), vitamin D3 (cholecalciferol), calcium, and a multivitamin initiated postoperatively and continued through the hard callus phase may improve healing biology and reduce complications. » High-risk patients require enhanced and extended protocols with close medical follow-up and comanagement with an internal medicine physician or appropriate specialist. Elderly, malnourished, polytrauma, open fracture, and comorbid patients benefit from additional conditionally essential amino acids-that is, amino acids that the body can synthesize under normal conditions but cannot produce in sufficient quantities during metabolic stress (including arginine, glutamine, and branched-chain amino acids)-and wound-healing cofactors, with supplementation often continued for 6 months or until radiographic union. Arginine and glutamine should be used with caution in patients with chronic kidney disease (estimated glomerular filtration…
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