Assessment of the relationship between timing of fixation of the fracture and secondary brain injury in patients with multiple trauma

Red Blood Cell Transfusion in Patients With Traumatic Brain Injury: A Systematic Review and Meta-Analysis

“…Fifteen studies [7,[26][27][28]32,33,[36][37][38][41][42][43]45,47,48] collected data on RBC transfusion during ICU stay or full hospitalization. Eighteen studies [7,17,[28][29][30][31][32][33][34][35][36][37][38][39]41,45,47,49] reported a proportion of missing data less than 10%.…”

“…Three were conducted in Canada; 2, in Taiwan; and others, in China, Columbia, Germany, Switzerland, Tunisia, or United Kingdom. Two studies [35,37] were completed before 1999, year of the publication of the TRICC trial [12]; 19 were conducted after its publication [7,17,[26][27][28][29][30][31]33,34,36,38,39,41,42,45,[47][48][49]; and 2 started before and ended after its publication [32,44]. One study did not report a specific timeframe [43].…”

“…Fifteen studies [7,17,27,29,30,32,35,37,39,43,[45][46][47][48][49] reported data on the quantity of RBC units transfused. The mean number of units varied between 1.8 and 6.1 units/transfused patient ( Table 3).…”

Use of the Licox® in a head-injured patient with a tibial shaft fracture: A novel method of assessing the effect of reamed intramedullary nailing on brain tissue oxygenation

“…15,30 In contrast, other authors have found no difference in outcome with respect to mortality, length of ICU stay, or neurologic outcome. 5,17,24,27,28,33 The Eastern Association of the Surgery of Trauma's review of the subject supported the latter by concluding that ''There is no compelling evidence that early long bone stabilization in mild, moderate, or severe brain injured patients either enhances or worsens outcome. 11 '' However, without high quality evidence supporting the safety of early long bone fracture fixation in head injured patients, concern persists that intramedullary nailing could adversely affect neurologic outcome.…”

“…8 The studies attempting to investigate this issue have been retrospective in design, used varying outcomes measures and endpoints, and thus, have come to dichotomous conclusions. 5,15,17,24,27,28,30,33 A recent study was able to demonstrate that intracranial pressure (ICP) increased while cerebral perfusion pressure (CPP) decreased after femoral nailing. 1 These findings suggest that intramedullary nailing may adversely affect cerebral oedema and perfusion in patients with head injury.…”