title: When should we operate on major fractures in patients with severe head injuries?
abstract: BACKGROUND
  The widely accepted practice of early fracture fixation (EFF) in multiply injured patients has recently been challenged in the presence of head injury.
  
  
  METHODS
  English and German language articles on the subject were searched using Medline. Keywords included head trauma, intracranial trauma, brain injuries, fractures, fracture fixation, timing, femur fracture, and tibia fracture.
  
  
  CONCLUSIONS
  The available literature does not provide clear-cut guidance on the management of fractures in the presence of head injuries. The trend is toward a better outcome if the fractures are fixed early. Treatment should therefore be tailored to the individual patient, with the assumption that full neurologic recovery will take place.
authors.affiliation: Department of Trauma and Orthopaedics, St. James' University Hospital, Leeds, Beckett St., LS9 7TF, Leeds, United Kingdom.
authors.forename: Peter V
authors.initials: PV
authors.lastname: Giannoudis
authors.forename: Veysi T
authors.initials: VT
authors.lastname: Veysi
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Pape
authors.forename: Cristian
authors.initials: C
authors.lastname: Krettek
authors.forename: Malcolm R
authors.initials: MR
authors.lastname: Smith
mesh_terms: D006259:Craniocerebral Trauma / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D005260:Female; D005264:Femoral Fractures / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D005858:Germany; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D009104:Multiple Trauma / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D017410:Practice Guidelines as Topic; D011379:Prognosis; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D015996:Survival Rate; D013978:Tibial Fractures / Q000150:complications / Q000401:mortality / Q000601:surgery*; D013997:Time Factors; D014218:Triage