The to acute respiratory distress syndrome(ARDS),acute renal failure(ARF)

The management of multiple injury are
very complex situation. For treatment of lower extremity, especially with
fracture femur in patients with multiple injuries. The controversy of evidences
about the optimal time to fixation divided commonly in two strategies, early
definite fixation and damage control orthopedics ( DCO). Early definitive fixation has perform within 24
hours after injury. The benefit of Early
definitive fixation has shown  lower of pulmonary  complications, short length of stay and
decrease morbidity.(1-4) But some evidences
suggest that early fixation of long bone can produces more complication in
patients with head injury and chest injury(5-7)  and can increase the inflammatory process,
hypoperfusion and ” second hit injury”.(8-10). For DCO, which
method can use for patients with multiple injuries and unstable conditions and
followed by definite fixation later.(11-14) DCO has shown the
advantage of early fixation foe example pulmonary function and relief pain.(14) And DCO can prevent
the complication from early definite fixation 
such as inflammatory condition may be leading to acute respiratory
distress syndrome(ARDS),acute renal failure(ARF) and multiple organ failure(MOF).(15,
16) Many evidences have
been support the benefit of DCO but contrary to the meta-analysis has shown
protective effect of early definite fixation from pulmonary complications
compare with DCO ( RR 0.30,0.22-0.40 90% CI).(17) But some data report no difference in
morbidity and  mortality between early
and late definite fixation of long bone.(18)

For the inconclusive about the evidence
which support the benefit of DCO compare with early definite fixation and the
optimal time to definite fixation of long bone for prevent any complications. The
aim of this study to determine the complication and effect of timing of
fixation and investigates risk factors for complications in multiple injuries
patients with lower extremity fracture.