Intramedullary Nailing in Multiple Trauma with Severe Head Injury: Benefit or Additional Damage?

Introduction

Head injury is one of the major problems in polytraumatized patients and occurs in about 66 % [7]. The acute trauma leads to primary brain damage which can be either focal (direct trauma) or diffuse (indirect trauma by, e. g., an acceleration-deceleration mechanism). The diffuse axonal injury is combined with a 35 % lethality [3]. After primary trauma the brain is vulnerable to further hypotension and hypoxia especially at day 1 and from day 6 to day 9 [6]. The disrupted cerebral autoregulation (local vasospasm, edema, activation and distribution of inflammatory cytokines) can initiate a circulus vitiosus that causes secondary brain damage.

Multiple trauma can be combined with severe head injury (Abbreviated Injury Scale = AIS 3+) and major fractures of the lower extremity. Optimal management means neuroprotective treatment and prevention of secondary brain damage by sufficient oxygenation and circulation regarding early fracture fixation and treatment of additional injuries. The main question for definite stabilization of the lower extremity shaft fractures is: early or delayed intramedullary nailing?

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