Head Injuries: Neurosurgical and Orthopedic Strategies

Abstract

Traumatic brain injury (TBI) represents the leading cause of death among young people in developed countries. Due to its highly complex pathophysiology, no therapeutic drugs have been identified. Although a large number of patients with skeletal injuries requiring operative fixation sustain an associated TBI, the ideal timing and modality of fracture fixation in head-injured patients remains a topic of lively debate. While several groups advocate immediate definitive fracture fixation (early total care), others prefer the concept of damage control orthopedics consisting of initial application of an external fixation and staged conversion to definitive internal fixation. In this chapter, we outline the pathophysiology of TBI and its impact on both fracture care and its associated clinical decision making.