The role of early operative fixation in polytrauma patients with long bone fractures was analyzed by comparing length of stay, intensive care unit days and ventilator days, incidence of pulmonary complications, infectious complications, orthopedic complications, and mortality in three groups: traction only, operative fixation later than 48 hours after admission, and operative fixation within 48 hours of admission. Patients in all groups were similar in mode of injury, age, and Injury Severity Scores. Patients with early operative fixation of long bone fractures had significantly (P less than .05) fewer pulmonary complications than either the traction or the late operative fixation group. No group routinely required ventilator support, even with attendant abdominal and chest trauma. Operative fixation of long bone fractures within 48 hours of admission in the multiply injured patient reduces pulmonary complications.