title: The management of femur shaft fracture associated with severe traumatic brain injury.
abstract: The aim of this article is to describe the management of femoral shaft fractures in patients with severe traumatic brain injury (TBI). This is a major problem and two questions remain currently of interest: When and how to perform orthopedic surgery in severe TBI patients? The main point of perioperative management remains the prevention of secondary brain insults and the monitoring of intracranial pressure is essential especially in patients with intracranial lesions on the CT-scan. The "double hit" concept, suggesting that surgery by itself might increase the preexisting systemic inflammatory response, gives argument for very early or delayed surgery. Early definitive femoral osteosynthesis, if requires lengthy surgical procedure, does not seem appropriate in this context and "damage-control orthopedics" with external fixation seems to be a good alternative.
authors.affiliation: Department of Anesthesiology and Intensive care, University Hospital of Toulouse, Équipe d'accueil « Modélisation de l'agression tissulaire et nociceptive », University Paul-Sabatier Toulouse 3, Hopital Purpan, 1, place du Dr-Baylac, 31059 Toulouse cedex 9, France.
authors.forename: S
authors.initials: S
authors.lastname: Mrozek
authors.forename: F
authors.initials: F
authors.lastname: Gaussiat
authors.forename: T
authors.initials: T
authors.lastname: Geeraerts
mesh_terms: D001930:Brain Injuries / Q000150:complications / Q000628:therapy*; D004632:Emergency Medical Services; D005264:Femoral Fractures / Q000150:complications / Q000628:therapy*; D005269:Femur / Q000473:pathology; D005592:Fracture Fixation; D006801:Humans; D019637:Orthopedic Procedures
keywords: Damage-control orthopedic; Double hit; Femoral fracture; Fracture de fémur; Severe traumatic brain injury; Traumatisme crânien grave