Orthopedic management of brain-injured adults. Part II.

Orthopedic management of the head trauma patient is divided into 3 phases--acute, recovery and stable. The treatment of bone injury is the main thrust in the acute phase. Guidelines were formulated from a retrospective review of 91 head trauma patients including spine and other fractures. The recovery phase consists of prevention and correction of joint deformities due to spasticity. Position, range of motion and splints are the basic methods employed. Indications and techniques for phenol injection to the posterior tibial and musculocutaneous nerves are reviewed. Heterotopic bone formation will be identified in this phase and treated early. In the final phase, one and one-half years postinjury, surgical treatment is employed to improve extremity function. Procedures proven of value in treatment of stroke patients are applicable. Heterotopic bone can also be definitively treated by excisional surgery supplemented by new medical agents.