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Hypothermia for traumatic head injury

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There is no evidence that hypothermia is beneficial in the treatment of head injury. Hypothermia should not be used except in the context of a high-quality randomised controlled trial with good allocation concealment.
Hypothermia has been used in the treatment of head …

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Mannitol for acute traumatic brain injury

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Mannitol therapy for raised intracranial pressure (ICP) may have a beneficial effect on mortality when compared with pentobarbital treatment, but it may have a detrimental effect on mortality compared with hypertonic saline. ICP-directed treatment shows a small beneficial effect compared to …

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Gangliosides for acute spinal cord injury

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The evidence available does not support the use of ganglioside treatment to reduce the death rate in spinal cord injury (SCI) patients. No evidence has yet emerged that ganglioside treatment improves recovery or quality of life in survivors.
SCI results in loss …

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Steroids for acute spinal cord injury

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Methylprednisolone has been shown to enhance sustained neurologic recovery in a phase III randomised trial; findings replicated in a second trial. Therapy must be started within 8 hours of injury using an initial bolus of 30 mg/kg by IV for 15 …

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Antifibrinolytic drugs for acute traumatic injury

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Tranexamic acid safely reduces mortality in bleeding trauma patients without increasing the risk of adverse events.  Tranexamic acid should be given as early as possible and within three hours of injury, as treatment later than this is unlikely to be effective.
Uncontrolled …

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Colloids versus crystalloids for fluid resuscitation in critically ill patients

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There is no evidence that resuscitation with colloids reduces the risk of death, compared to resuscitation with crystalloids, in patients with trauma, burns or following surgery. Furthermore, the use of hydroxyethyl starch might increase mortality. As colloids are not associated with …

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Internal fixation implants for intracapsular hip fractures in adults

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There were no major differences in patient survival or complications related to the operation, using different implants for internal fixation of intracapsular hip fractures, from the available evidence within randomised trials.
Numerous different implants with screws, pins and side plates have been used …

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Extramedullary fixation implants and external fixators for extracapsular hip fractures in adults

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Sliding Hip Screws (SHS) appear to be preferable for fixation of hip fractures in adults, given the markedly increased fixation failure rate of fixed nail plates.
Extramedullary fixation of hip fractures involves the application of a plate and screws to the lateral …

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Dynamic compression plating versus locked intramedullary nailing for humeral shaft fractures in adults

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Intramedullary nailing is associated with an increased risk of shoulder impingement, with a related increase in restriction of shoulder movement and need for removal of metalwork. There is not enough evidence to determine if there were any other important differences, including in …

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Perioperative fluid volume optimization following proximal femoral fracture

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Limited low quality and weak evidence from randomised controlled trials to support the use of advanced haemodynamic monitoring compared to protocol using standard measures such as CVP for perioperative fluid volume optimisation for patients with proximal femoral fracture exists.   Research findings …

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