The polytrauma patient who sustains a significant head injury (head and neck Abbreviated Injury Scale of 3 or greater) will require prolonged and technically demanding operative intervention for musculoskeletal and associated soft tissue trauma. The presence of a head injury may delay the immediate surgical intervention for long bone injuries, which has proven to have major advantages for patient care and well-being. This retrospective review of the Sunnybrook Health Science Centre experience between January 1, 1986, and June 1, 1988, identified 153 polytrauma patients with a significant head injury. Forty-five died from complications unrelated to their long bone injuries or treatment thereof, not surviving long enough to reach the operating room for stabilization of their long bone fractures. The 108 survivors sustained 188 long bone injuries, 63 of which were open fractures. Twenty patients were treated nonoperatively. The 88 patients treated operatively had 12 complications: one peroneal nerve palsy; five cases of sepsis (three in open fractures and all resolving with removal of fixation devices); three malunions; and three cases of delayed union. Sixty-nine patients (78%) were available for long-term follow-up, 64 (93%) making a full recovery. Seven required additional surgery to achieve this goal and another patient awaits an ankle arthrodesis. Examining the head and neck AIS and Injury Severity Score of this group showed that 50 (46%) of these patients were expected to die and 22 (44%) made a full recovery.(ABSTRACT TRUNCATED AT 250 WORDS)