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Management des Schwerverletzten pp 117–123Cite as

Schädel-Hirn-Trauma: Einfluss auf die unfallchirurgische Akutversorgung

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Zusammenfassung

Das Schädel-Hirn-Trauma (SHT) stellt nach wie vor die wesentliche Todesursache junger Patienten im Alter unter 40 Jahren dar. Sekundäre Hirnschäden sind vorwiegend für die schlechte Prognose nach SHT verantwortlich. Das initiale Trauma führt zu einer massiven intrakraniellen Entzündungsreaktion mit nachfolgender Entwicklung eines posttraumatischen Hirnödems und einer verzögerten Neurotoxizität. Es ist deshalb bei der Akutversorgung schwerverletzter Patienten von entscheidender Bedeutung, die unterliegenden pathophysiologischen Implikationen zu verstehen und betreffend des Zeitpunktes und der Behandlungsmodalität assoziierter Verletzungen zu beachten. Hierbei werden biomechanische Gesichtspunkte der Frakturversorgung der Priorität der intensivmedizinischen SHT-Therapie untergeordnet, mit dem Ziel sekundäre intrazerebrale Insulte («2nd hits») zu vermeiden. Moderne Strategien des SHT-Managements bei schwerverletzten Patienten werden in diesem Kapitel beschrieben, mit besonderer Berücksichtigung der unterliegenden neuroinflammatorischen Pathophysiologie.

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Literatur

  • Anglen JO, Luber K, Park T (2003) The effect of femoral nailing on cerebral perfusion pressure in head-injured patients. J Trauma 54: 1166–1170

    Google Scholar 

  • Bayir H, Clark RS, Kochanek PM (2003) Promising strategies to minimize secondary brain injury after head trauma. Crit Care Med 31: S112–117

    Google Scholar 

  • Beauchamp K, Mutlak H, Smith WR, Shohami E, Stahel PF (2008) Pharmacology of traumatic brain injury: where is the «golden bullet»? Mol Med 14: 731–740

    Google Scholar 

  • Bone LB, Johnson KD, Weigelt J, Scheinberg R (1989) Early versus delayed stabilization of femoral fractures: A prospective randomized study. J Bone Joint Surg (Am) 71: 336–340

    Google Scholar 

  • Brennan FH, Anderson AJ, Taylor SM, Woodruff TM, Ruitenberg MJ (2012) Complement activation in the injured central nervous system: another dual-edged sword? J Neuroinflammation 9: 137

    Google Scholar 

  • Chesnut RM (1995) Secondary brain insults after head injury: clinical perspectives. New Horiz 3: 366–375

    Google Scholar 

  • Chesnut RM, Marshall SB, Piek J, Blunt BA, Klauber MR, Marshall LF (1993a) Early and late systemic hypotension as a frequent and fundamental source of cerebral ischemia following severe brain injury in the Traumatic Coma Data Bank. Acta Neurochir Suppl (Wien) 59: 121–125

    Google Scholar 

  • Chesnut RM, Marshall LF, Klauber MR, Blunt BA, Baldwin N, Eisenberg HM, Jane JA, Marmarou A, Foulkes MA (1993b) The role of secondary brain injury in determining outcome from severe head injury. J Trauma 34: 216–222

    Google Scholar 

  • Childs BR, Nahm NJ, Moore TA, Vallier HA (2016) Multiple procedures in the initial surgical setting: when do the benefits outweigh the risks in patients with multiple system trauma? J Orthop Trauma 30: 420–425

    Google Scholar 

  • Corrigan F, Mander KA, Leonard AV, Vink R (2016) Neurogenic inflammation after traumatic brain injury and its potentiation of classical inflammation. J Neuroinflammation 13: 264

    Google Scholar 

  • Edwards P, et al. (2005) Final results of MRC CRASH, a randomised placebo-controlled trial of intravenous corticosteroid in adults with head injury – outcomes at 6 months. Lancet 365: 1957–1959

    Google Scholar 

  • Elf K, Nilsson P, Enblad P (2003) Prevention of secondary insults in neurointensive care of traumatic brain injury. Eur J Trauma 29: 74–80

    Google Scholar 

  • Flierl MA, Stoneback JW, Beauchamp KM, Hak DJ, Morgan SJ, Smith WR, Stahel PF (2010) Femur shaft fracture fixation in head-injured patients – when is the right time? J Orthop Trauma 24: 107–114

    Google Scholar 

  • Gandhi RR, Overton TL, Haut ER, Lau B, Vallier HA, Rohs T, Hasenboehler E, Lee JK, Alley D, Watters J, Rogers FB, Shafi S (2014) Optimal timing of femur fracture stabilization in polytrauma patients: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg 77: 787–795

    Google Scholar 

  • Geeraerts T, Friggeri A, Mazoit JX, Benhamou D, Duranteau J, Vigue B (2008) Posttraumatic brain vulnerability to hypoxia-hypotension: the importance of the delay between brain trauma and secondary insult. Intensive Care Med 34: 551–560

    Google Scholar 

  • Giannoudis PV, Veysi VT, Pape HC, Krettek C, Smith MR (2002) When should we operate on major fractures in patients with severe head injuries? Am J Surg 183: 261–267

    Google Scholar 

  • Gomez PA, de-la-Cruz J. Lora D, Jimenez-Roldan L, Rodriguez-Boto G, Sarabia R, Sahuquillo J, Lastra R, Morera J, Lazo E, Dominguez J, Ibanez J, Brell M, de-la-Lama A, Lobato RD, Lagares A (2014) Validation of a prognostic score for early mortality in severe head injury cases. J Neurosurg 121: 1314–1322

    Google Scholar 

  • Hardy BM, Yoshino O, Quail AW, Balogh ZJ (2015) Influence of the timing of internal fixation of femur fractures during shock resuscitation on remote organ damage. ANZ J Surg 85: 966–971

    Google Scholar 

  • Hellewell S, Semple BD, Morganti-Kossmann MC (2016) Therapies negating neuroinflammation after brain trauma. Brain Res 1640: 36–56

    Google Scholar 

  • Iorio-Morin C, Fortin D, Blanchard J (2016) TBI prognosis calculator: a mobile application to estimate mortality and morbidity following traumatic brain injury. Clin Neurol Neurosurg 142: 48–53

    Google Scholar 

  • Jaicks RR, Cohn SM, Moller BA (1997) Early fracture fixation may be deleterious after head injury. J Trauma 42: 1–5

    Google Scholar 

  • Maas AI, Lingsma HF, Roozenbeek B (2015) Predicting outcome after traumatic brain injury. Handb Clin Neurol 128: 455–474

    Google Scholar 

  • Marshall LF, Marshall SB, Klauber MR, Van Berkum Clark M, Eisenberg H, Jane JA, Luerssen TG, Marmarou A, Foulkes MA (1992) The diagnosis of head injury requires a classification based on computed axial tomography. J Neurotrauma 9 (Suppl 1): S287–S292

    Google Scholar 

  • McCredie VA, Alali AS, Xiong W, Rubenfeld GD, Cuthbertson BH, Scales DC, Nathens AB (2016) Timing of withdrawal of life-sustaining therapies in severe traumatic brain injury: Impact on overall mortality. J Trauma Acute Care Surg 80: 484–491

    Google Scholar 

  • Morganti-Kossmann MC, Rancan M, Stahel PF, Kossmann T (2002) Inflammatory response in acute traumatic brain injury: a double-edged sword. Curr Opin Crit Care 8: 101–105

    Google Scholar 

  • Mousavi M, Kolonja A, Schaden E, Gabler C, Ehteshami JR, Vecsei V (2001) Intracranial pressure-alterations during controlled intramedullary reaming of femoral fractures: an animal study. Injury 32: 679–682

    Google Scholar 

  • Neher M, Weckbach S, Flierl MA, Huber-Lang MS, Stahel PF (2011) Molecular mechanisms of inflammation and tissue injury after major trauma – is complement the «bad guy»? J Biomed Sci 18: 90

    Google Scholar 

  • Neher MD, Keene CN, Rich MC, Moore HB, Stahel PF (2014) Serum biomarkers for traumatic brain injury. South Med J 107: 248–255

    Google Scholar 

  • Odgaard L, Johnsen SP, Pedersen AR, Nielsen JF (2017) Return to Work After Severe Traumatic Brain Injury: A Nationwide Follow-up Study. J Head Trauma Rehabil 32: E57–E64

    Google Scholar 

  • Pape HC, Giannoudis P, Krettek C (2002) The timing of fracture treatment in polytrauma patients: relevance of damage control orthopedic surgery. Am J Surg 183: 622–629

    Google Scholar 

  • Pape HC, Giannoudis PV, Krettek C, Trentz O (2005) Timing of fixation of major fractures in blunt polytrauma: role of conventional indicators in clinical decision making. J Orthop Trauma 19: 551–562

    Google Scholar 

  • Pape HC, Griensven MV, Hildebrand FF, Tzioupis CT, Sommer KL, Krettek CC, Giannoudis PV (2008) Systemic inflammatory response after extremity or truncal fracture operations. J Trauma 65: 1379–1384

    Google Scholar 

  • Pearn ML, Niesman IR, Egawa J, Sawada A, Almenar-Queralt A, Shah SB, Duckworth JL, Head BP (2017) Pathophysiology Associated with Traumatic Brain Injury: Current Treatments and Potential Novel Therapeutics. Cell Mol Neurobiol 37(4): 571–585

    Google Scholar 

  • Qullinan N, Herson PS, Traystman RJ (2016) Neuropathophysiology of brain injury. Anesthesiol Clin 34: 453–464

    Google Scholar 

  • Reich MS, Dolenc AJ, Moore TA, Vallier HA (2016) Is Early Appropriate Care of axial and femoral fractures appropriate in multiply-injured elderly trauma patients? J Orthop Surg Res 11: 106

    Google Scholar 

  • Rich MC, Keene CN, Neher MD, Johnson K, Yu ZX, Ganivet A, Holers VM, Stahel PF (2016) Site-targeted complement inhibition by a complement receptor 2-conjugated inhibitor (mTT30) ameliorates post-injury neuropathology in mouse brains. Neurosci Lett 617: 188–194

    Google Scholar 

  • Scalea TM (2008) Optimal timing of fracture fixation: have we learned anything in the past 20 years? J Trauma 65: 253–260

    Google Scholar 

  • Schmidt OI, Heyde CE, Ertel W, Stahel PF (2005) Closed head injury: an inflammatory disease? Brain Res Rev 48: 388–399

    Google Scholar 

  • Stahel PF (2012) Pupil evaluation in addition to Glasgow Coma Scale components in prediction of traumatic brain injury and mortality. Br J Surg 99 (Suppl 1): 131

    Google Scholar 

  • Stahel PF, Barnum SR (2006) The role of the complement system in CNS inflammatory diseases. Expert Rev Clin Immunol 2: 445–456

    Google Scholar 

  • Stahel PF, Smith WR (2011) Closed head injury. In: Trauma Surgery – Handbooks in General Surgery. Bland KI, Sarr MG, Büchler MW, Csendes A, Garden OJ, Wong J (Eds.), Springer, London, pp. 83–101

    Google Scholar 

  • Stahel PF, Flierl MA (2016) Head injuries: neurosurgical and orthopaedic strategies. In: The Poly-Traumatized Patient with Fractures: A Multi-Disciplinary Approach. Pape HC, Sanders R, Borrelli J, Jr (Eds.), Springer, Berlin/Heidelberg, 2nd edition, pp. 55–64

    Google Scholar 

  • Stahel PF, Ertel W, Heyde CE (2005a) Einfluss des Schädel-Hirn-Traumas auf Zeitpunkt und Technik der Frakturversorgung. Orthopäde 34: 852–864

    Google Scholar 

  • Stahel PF, Heyde CE, Wyrwich W, Ertel W (2005b) Aktuelle Konzepte des Polytrauma Managements: von ATLS zu «Damage Control». Orthopäde 34: 823–836

    Google Scholar 

  • Stahel PF, Smith WR, Moore EE (2008) Hypoxia and hypotension, the «lethal duo» in traumatic brain injury – implications for prehospital care. Intensive Care Med 34: 402–404

    Google Scholar 

  • Stahel PF, Flierl MA, Morgan BP, Persigehl I, Stoll C, Conrad C, Touban BM, Smith WR, Beauchamp K, Schmidt OI, Ertel W, Leinhase I (2009a) Absence of the complement regulatory molecule CD59a leads to exacerbated neuropathology after traumatic brain injury in mice. J Neuroinflammation 6: 2

    Google Scholar 

  • Stahel PF, Smith WR, Moore EE (2009b) Current trends in resuscitation strategy for the multiply injured patient. Injury 40 (Suppl 4): S27–S35

    Google Scholar 

  • Starr AJ, Hunt JL, Chason DP, Reinert CM, Walker J (1998) Treatment of femur fracture with associated head injury. J OrthopTrauma 12: 38–45

    Google Scholar 

  • Stocchetti N, Zanier ER (2016) Chronic impact of traumatic brain injury on outcome and quality of life: a narrative review. Crit Care 20: 148

    Google Scholar 

  • Townsend RN, Lheureau T, Protech J, Riemer B, Simon D (1998) Timing fracture repair in patients with severe brain injury (Glasgow Coma Scale score <9). J Trauma 44: 977–982

    Google Scholar 

  • Vallier HA, Moore TA, Como JJ, Wilczewski PA, Steinmetz MP, Wagner KG, Smith CE, Wang XF, Dolenc AJ (2015) Complications are reduced with a protocol to standardize timing of fixation based on response to resuscitation. J Orthop Surg Res 10: 155

    Google Scholar 

  • Velmahos GC, Arroyo H, Ramicone E, Cornwell EEr, Murray JA, Asensio JA, Berne TV, Demetriades D (1998) Timing of fracture fixation in blunt trauma patients with severe head injuries. Am J Surg 176: 324–329

    Google Scholar 

  • Zador Z, Sperrin M, King AT (2016) Predictors of Outcome in Traumatic Brain Injury: New Insight Using Receiver Operating Curve Indices and Bayesian Network Analysis. PLoS One 11: e0158762

    Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Denver Health Medical Center, Bannock Street 777, CO 80204, Denver, USA

    Prof. Dr. med. P. F. Stahel

  2. Klinik für Orthopädie, Universitätsklinikum Ulm, RKU, Oberer Eselsberg 45, 89081, Ulm, Deutschland

    PD Dr. med. S. Weckbach

Authors
  1. Prof. Dr. med. P. F. Stahel
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  2. PD Dr. med. S. Weckbach
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Corresponding authors

Correspondence to P. F. Stahel or S. Weckbach .

Editor information

Editors and Affiliations

  1. Universitätsspital Zürich, Zürich, Switzerland

    Hans-Christoph Pape

  2. Klinik für Unfall- und Wiederherstellung, Universitätsklinikum RWTH Aachen, Aachen, Deutschland

    Frank Hildebrand

  3. Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Marburg, Marburg, Deutschland

    Steffen Ruchholtz

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Stahel, P.F., Weckbach, S. (2018). Schädel-Hirn-Trauma: Einfluss auf die unfallchirurgische Akutversorgung. In: Pape, HC., Hildebrand, F., Ruchholtz, S. (eds) Management des Schwerverletzten. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-54980-3_13

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  • DOI: https://doi.org/10.1007/978-3-662-54980-3_13

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-54979-7

  • Online ISBN: 978-3-662-54980-3

  • eBook Packages: Medicine (German Language)

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