Assessment of the relationship between timing of fixation of the fracture and secondary brain injury in patients with multiple trauma.
BACKGROUND
It has been suggested that early fixation of a fracture is deleterious to eventual neurologic outcome. We undertook this study to determine whether the timing of fracture fixation is correlated to neurologic outcome.


METHODS
We retrospectively reviewed patients with severe head and orthopedic injuries requiring fracture fixation. Patients were divided into two groups: early fracture fixation (< 24 hours after injury) and late fracture fixation (> 24 hours after injury).


RESULTS
One hundred twenty-three patients met entry criteria. During fracture fixation, the early group had a significant 2-, 3-, and 2-fold increase in crystalloid, blood infusion, and blood loss, respectively. There was no difference in oxygen saturation and systolic blood pressure or episodes of cranial hypertension or hypoperfusion. There was no difference in outcomes as measured by in-hospital complications, stay in the intensive care unit or hospital, mortality rates, hospital discharge or follow-up Glasgow Coma Scores, or long-term orthopedic or neurologic results.


CONCLUSIONS
Patients undergoing fracture fixation with severe head injury mandate monitoring of intracranial pressure and perfusion and tailored fluid resuscitation to meet specific organ end points. Integrating end organ perfusion and pressure with meticulous fluid status during the definitive repair phase may reduce the exposure to secondary brain injury in patients undergoing early fracture fixation.
Kalb
D C
DC
Department of Surgery, Hennepin County Medical Center, University of Minnesota, Minneapolis 55415, USA.
Ney
A L
AL
Rodriguez
J L
JL
Jacobs
D M
DM
Van Camp
J M
JM
Zera
R T
RT
Rockswold
G L
GL
West
M A
MA
D000328:Adult; D001930:Brain Injuries / Q000150:complications / Q000503:physiopathology*; D002560:Cerebrovascular Circulation; D006259:Craniocerebral Trauma / Q000150:complications; D005260:Female; D005592:Fracture Fixation / Q000009:adverse effects*; D050723:Fractures, Bone / Q000150:complications; D006801:Humans; D007427:Intracranial Pressure; D008297:Male; D009104:Multiple Trauma / Q000628:therapy*; D012151:Resuscitation; D012189:Retrospective Studies; D013997:Time Factors