PubMed · 3894745
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S B Sheehy. Trauma patient guidelines.. https://pubmed.ncbi.nlm.nih.gov/3894745/
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BACKGROUND: The widely accepted practice of early fracture fixation (EFF) in multiply injured patients has recently been challenged in the presence of head injury. DATA SOURCES: English and German language articles on the subject were searched using Medline. Keywords included head trauma, intracranial trauma, brain injuries, fractures, fracture fixation, timing, femur fracture, and tibia fracture. CONCLUSIONS: The available literature does not provide clear-cut guidance on the management of fractures in the presence of head injuries. The trend is toward a better outcome if the fractures are fixed early. Treatment should therefore be tailored to the individual patient, with the assumption that full neurologic recovery will take place.
This study surveyed admissions of patients with trauma caused by seizures from a population of over 400 000 to a Regional Neurosurgery, Plastic Surgery, Orthopaedic Surgical Services and a short-stay ward. Information on duration of epilepsy, seizure type, antiepileptic drugs (AEDs) and the co-existence of other neurological or psychiatric factors was reviewed and the hospital costs calculated. Twelve patients (eight males, four females, aged 28 to 78 years) had 13 admissions with 14 injuries caused by seizures during the period August 1995 to November 1998 (1% of the total admissions with the diagnosis of epilepsy). Seven had head-injuries, four had limb fractures or dislocations, two had burns and one had severe lacerations. The average duration of stays were between 1 day (short-stay ward) and 9-24 days for the three major services. The direct healthcare costs of this small group were high ( Ł 49 421) or Ł 3802 per traumatic incident. Clinical review suggested that the trauma could have been prevented by alternative care in seven patients at the most optimistic. Epilepsy is uncommon as a cause of severe trauma, the seizures may be difficult to prevent and the direct healthcare costs are high.
WE REVIEW THE phenomenology, pathophysiology, pathological anatomy, and therapy of posttraumatic movement disorders with special emphasis on neurosurgical treatment options. We also explore possible links between craniocerebral trauma and parkinsonism. The cause-effect relationship between head injury and subsequent movement disorder is not fully appreciated. This may be related partially to the delayed appearance of the movement disorder. Movement disorders after severe head injury have been reported in 13 to 66% of patients. Although movement disorders after mild or moderate head injury are frequently transient and, in general, do not result in additional disability, kinetic tremors and dystonia may be a source of marked disability in survivors of severe head injury. Functional stereotactic surgery provides long-term symptomatic and functional benefits in the majority of patients. Thalamic radiofrequency lesioning, although beneficial in some patients, frequently is associated with side effects such as increased dysarthria or gait disturbance, particularly in patients with kinetic tremor secondary to diffuse axonal injury. Deep brain stimulation is used increasingly as an option in such patients. It remains unclear whether pallidal or thalamic targets are more beneficial for treatment of posttraumatic dystonia. Trauma to the central nervous system is an important causative factor in a variety of movement disorders. The mediation of the effects of trauma and the pathophysiology of the development of posttraumatic movement disorders require further study. Functional stereotactic surgery should be considered in patients with disabling movement disorders refractory to medical treatment.