Femur shaft fracture fixation in head-injured patients: when is the right time?
The ideal timing and modality of femur shaft fracture fixation in head-injured patients remains a topic of debate. Several groups advocate the immediate definitive fixation of femur fractures ("early total care"), whereas others support the concept of "damage control orthopaedics" with temporary fracture fixation by means of external fixation and staged, planned conversion to internal fixation. The present review was designed to address this unresolved controversy by outlining the underlying immunopathophysiology of traumatic brain injury and providing clinical recommendations on the timing of femur shaft fracture fixation in patients with severe head injuries.
Flierl
Michael A
MA
Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO 80204, USA. philip.stahel@dhha.org
Stoneback
Jason W
JW
Beauchamp
Kathryn M
KM
Hak
David J
DJ
Morgan
Steven J
SJ
Smith
Wade R
WR
Stahel
Philip F
PF
D001930:Brain Injuries / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D019091:Critical Pathways / Q000592:standards; D005264:Femoral Fractures / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D005592:Fracture Fixation; D015600:Glasgow Coma Scale; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D013997:Time Factors