• F Gaussiat.
• Department of Anesthesiology and Intensive care, University Hospital of Toulouse, Équipe d'accueil « Modélisation de l'agression tissulaire et nociceptive », University Paul-Sabatier Toulouse 3, Hopital Purpan, 1, place du Dr-Baylac, 31059 Toulouse cedex 9, France.
• Ann Fr Anesth Reanim. 2013 Jul 1;32(7-8):510-5.

AbstractThe aim of this article is to describe the management of femoral shaft fractures in patients with severe traumatic brain injury (TBI). This is a major problem and two questions remain currently of interest: When and how to perform orthopedic surgery in severe TBI patients? The main point of perioperative management remains the prevention of secondary brain insults and the monitoring of intracranial pressure is essential especially in patients with intracranial lesions on the CT-scan. The "double hit" concept, suggesting that surgery by itself might increase the preexisting systemic inflammatory response, gives argument for very early or delayed surgery. Early definitive femoral osteosynthesis, if requires lengthy surgical procedure, does not seem appropriate in this context and "damage-control orthopedics" with external fixation seems to be a good alternative.Copyright © 2013. Published by Elsevier SAS.

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