When should we operate on major fractures in patients with severe head injuries?

Giannoudis, Peter V.; Veysi, Veysi T.; Pape, Hans-Christian; Krettek, Christian; Smith, Malcolm R

doi:10.1016/s0002-9610(02)00783-3

Cited by 74 publications

(25 citation statements)

References 43 publications

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“…If the patient relates nocturnal or early morning erections, serious underlying organic pathology is thought to be unlikely, and the case is more likely to be psychogenic. 27 King 28 reported sexual impotence in 16 (20%) of 90 male patients which was more likely to be associated with a urethral injury. Ellison et al 29 reported on a series of 42 men with pelvic fractures and noted that at 20-month follow-up, persistent impotence was associated with vasculogeneic trauma.…”

Section: Sexual Dysfunction In Males After Pelvic Fracturementioning

confidence: 99%

(iv) Pelvic fractures and genitourinary injuries

Yerasimides¹,

Roberts²

2005

Current Orthopaedics

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Section: Sexual Dysfunction In Males After Pelvic Fracturementioning

confidence: 99%

(iv) Pelvic fractures and genitourinary injuries

Yerasimides¹,

Roberts²

2005

Current Orthopaedics

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“…Improved neurological outcome is reported after early decompression in animal experiments [7,14,17,18,52]. Advantages of early femur fracture fixation are well known and reported by several studies [5,6,10,20,24,40,47]. Clinical research in the past decade suggests that early stabilization of spinal fractures may improve neurological outcome, reduce complications, ICU and hospital stay [8,10,11,19,26,30,32,36,41,45,49].…”

Section: Introductionmentioning

confidence: 98%

Timing of thoracic and lumbar fracture fixation in spinal injuries: a systematic review of neurological and clinical outcome

2006

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Abstracts A systematic review of all available evidence on the timing of surgical fixation for thoracic and lumbar fractures with respect to clinical and neurological outcome was designed. The purpose of this review is to clarify some of the controversy about the timing of surgical fracture fixation in spinal trauma. Better neurological outcome, shorter hospital stay and fewer complications have been reported after early fracture fixation. But there are also studies showing no difference in neurological outcome when compared to late treatment. Mortality is another controversial point since a recent report of higher mortality in early treated patients. A systematic review of the literature was preformed. Ten articles were included. Early fracture fixation is associated with less complications, shorter hospital and ICU stay. The effect of early treatment on the neurological outcome remains unclear due to the contradictory results of the included studies. Early thoracic and lumbar fracture fixation results in improvement of clinical outcome, but the effect on neurological outcome remains controversial.

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“…The debate regarding Physiological assessment of the polytrauma patient 563 DCO versus ETC is currently ongoing, especially in patients with head and chest injuries, where ETC is thought to be potentially harmful [13,14,64]. It has been shown that patients with longer surgery time do have a higher incidence of ARDS and MOF [26].…”

Section: Multiple Skeletal Injuriesmentioning

confidence: 99%

Physiological assessment of the polytrauma patient: initial and secondary surgeries

Enninghorst

Peralta

Yoshino

et al. 2011

Eur J Trauma Emerg Surg

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The timing of fracture fixation in polytrauma patients has been debated for a long time. The decision between DCO (damage control orthopaedics) and ETC (early total care) is a difficult dilemma. Overzealous ETC in haemodynamically compromised patients with significant chest and head injuries can be detrimental. It has been shown, however, that early fracture fixation has a trend towards better outcome in patients with less severe injuries. Delaying all orthopaedic surgery in critically injured patients can be a safe alternative, but has several disadvantages like longer ICU stay and septic complications. The literature shows equivocal evidence for both settings. This article will summarize the historical background and controversies regarding patient assessment and decision making during the treatment of polytrauma patients. It will also give guidance for choosing DCO versus ETC in the clinical setting.

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When should we operate on major fractures in patients with severe head injuries?

Cited by 74 publications

References 43 publications

(iv) Pelvic fractures and genitourinary injuries

(iv) Pelvic fractures and genitourinary injuries

Timing of thoracic and lumbar fracture fixation in spinal injuries: a systematic review of neurological and clinical outcome

Physiological assessment of the polytrauma patient: initial and secondary surgeries

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