[Surgical strategy in the treatment of cranio-cerebral injuries associated with fractures of tubular bones].

The work is based on the analysis of 450 patients with combined injury; 272 of them underwent osteosynthesis in different periods after the injury. Examination and treatment of the combined injuries must be conducted simultaneously. Operations on the extremities are performed only after the patient recovers from shock. Indications and contraindications for applying instrumental methods of examination are discussed. The volume of the neurosurgical intervention in patients with combined craniocerebral injury comprises removal of the hematoma, correction and prevention of dislocation and secondary compression of the brain stem in the postoperative period, and hemostasis. Preference is given to resection trephination and to encephalotomy for removing an intracerebral hematoma. Secondary stem disorders are managed by tentoriotomy; ventricular drainage is applied in hydrocephalus. A classification is suggested which takes into account the severity of the craniocerebral injury and the severity of the injury to the extremity.