title: Timing of long bone fracture fixation in severe traumatic brain injury.
abstract: We present a review of the published evidence on the optimal timing for long bone fracture fixation in severe traumatic brain injury (TBI); a matter that remains under debate. Fifteen retrospective articles (level II-3 evidence) were considered suitable for the review. We conclude that the published evidence does not provide a definitive answer to the optimal timing of long bone fracture surgery in severe TBI, and a randomized controlled trial is required. We recommend a safe strategy that combines damage control surgery with a period of monitoring of intracranial pressure, cerebral perfusion pressure, and if available brain tissue oxygen until the patient is considered fit for the fracture fixation.
authors.affiliation: Trauma and Orthopedics Department, Kettering General Hospital, Kettering, Northamptonshire, UK. jamjoomab@gmail.com
authors.forename: Bakur A
authors.initials: BA
authors.lastname: Jamjoom
authors.forename: Abdulhakim B
authors.initials: AB
authors.lastname: Jamjoom
mesh_terms: D001930:Brain Injuries / Q000150:complications*; D005592:Fracture Fixation / Q000009:adverse effects / Q000379:methods*; D050723:Fractures, Bone / Q000150:complications* / Q000601:surgery*; D006801:Humans; D013997:Time Factors