Early vs Late Fixation of Extremity Fractures Among Adults With Traumatic Brain  Injury.

[en] IMPORTANCE: The optimal timing for fixation of extremity fractures after traumatic brain injury (TBI) remains controversial. OBJECTIVE: To investigate whether patients who underwent extremity fixation within 24 hours of TBI experienced worse outcomes than those who had the procedure 24 hours or more after TBI. DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. Patients 16 years or older with TBI who underwent internal extremity fixation met inclusion criteria. To compare outcomes, patients who underwent the procedure within 24 hours were propensity score matched with those who underwent it 24 hours or later. Patients were treated from December 9, 2014, to December 17, 2017. Data analysis was conducted between August 1, 2022, and December 25, 2023. MAIN OUTCOMES AND MEASURES: The primary outcome was an unfavorable functional status at 6 months (Glasgow Outcome Scale-Extended [GOSE] score ≤4). RESULTS: A total of 253 patients were included in this study. The median age was 41 (IQR, 27-57) years, and 184 patients (72.7%) were male. The median Injury Severity Score (ISS) was 41 (IQR, 27-49). Approximately half of the patients (122 [48.2%]) had a mild TBI while 120 (47.4%) had moderate to severe TBI. Seventy-four patients (29.2%) underwent an internal extremity fixation within 24 hours, while 179 (70.8%) had the procedure 24 hours or later. At 6 months, 86 patients (34.0%) had an unfavorable functional outcome. After propensity score matching, there were no statistically significant differences in unfavorable functional outcomes at 6 months (odds ratio [OR], 1.12 [95% CI, 0.51-1.99]; P = .77) in patients with TBI of any severity. Similar results were observed in patients with mild TBI (OR, 0.71 [95% CI, 0.22-2.29]; P = .56) and moderate to severe TBI (OR, 1.08 [95% CI, 0.32-3.70]; P = .90). CONCLUSIONS AND RELEVANCE: The outcomes of extremity fracture fixation performed within 24 hours after TBI appear not to be worse than those of procedures performed 24 hours or later. This finding suggests that early fixation after TBI could be considered in patients with mild head injuries.

Disciplines :

Human health sciences: Multidisciplinary, general & others

Author, co-author :

Zheng, Jiang; Department of Anesthesiology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, China.

Ouyang, Yufang; Department of Anesthesiology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, China.

Zhang, Ke; Department of Anesthesiology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, China.

Wang, Zhixing; Department of Anesthesiology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, China.

Younsi, Alexander; Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany.

Alhalabi, Obada; Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany.

Fu, Hong; Department of Anesthesiology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, China.

Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain

Other collaborator :

Rosand, Jonathan

Correia, Marta

Gagliardo, Pablo

Vespa, Paul M

Stevens, Robert

Furmanov, Alex

Brazinova, Alexandra

Ghuysen, Alexandre ; Université de Liège - ULiège > Département des sciences de la santé publique > Simulation médicale en situation critique

Lagares, Alfonso

Kowark, Ana

More authors (243 more)

Language :

English

Title :

Early vs Late Fixation of Extremity Fractures Among Adults With Traumatic Brain Injury.

Publication date :

04 March 2024

Journal title :

JAMA Network Open

eISSN :

2574-3805

Publisher :

JAMA Network, Us

Volume :

Issue :

Pages :

e241556

Peer reviewed :

Peer Reviewed verified by ORBi

Available on ORBi :

since 28 April 2025

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