Early fracture fixation may be "just fine" after head injury: no difference in central nervous system outcomes.
BACKGROUND
Recent reports suggest that early fracture fixation worsens central nervous system (CNS) outcomes. We compared discharge Glasgow Coma Scale (GCS) scores, CNS complications, and mortality of severely injured adults with head injuries and pelvic/lower extremity fractures treated with early versus delayed fixation.


METHODS
Using trauma registry data, records meeting preselected inclusion criteria from the years 1991 to 1995 were examined. We identified 171 patients aged 14 to 65 years (mean age, 32.7 years) with head injuries and fractures who underwent early fixation (< or = 24 hours after admission) (n = 147) versus delayed fixation (> 24 hours after admission) (n = 24).


RESULTS
Patients were severely injured, with a mean admission GCS score of 9.1, Revised Trauma Score of 6.2, Injury Severity Score of 38, median intensive care unit length of stay of 16.5 days, and hospital length of stay of 23 days. No differences between groups were found by age, admission GCS score, Injury Severity Score, Revised Trauma Score, intensive care unit length of stay, hospital length of stay, shock, vasopressors, major nonorthopedic operative procedures, total intravenous fluids or blood products, or mortality rates. In survivors, no differences in discharge GCS scores or CNS complications were found.


CONCLUSIONS
We found no evidence to suggest that early fracture fixation negatively influences CNS outcomes or mortality.
Scalea
T M
TM
R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore 21201-1595, USA.
Scott
J D
JD
Brumback
R J
RJ
Burgess
A R
AR
Mitchell
K A
KA
Kufera
J A
JA
Turen
C
C
Champion
H R
HR
D000293:Adolescent; D000328:Adult; D000368:Aged; D002493:Central Nervous System Diseases / Q000209:etiology*; D000075202:Contraindications; D006259:Craniocerebral Trauma / Q000150:complications / Q000628:therapy; D005440:Fluid Therapy; D005592:Fracture Fixation / Q000009:adverse effects; D015600:Glasgow Coma Scale; D006801:Humans; D007869:Leg Injuries / Q000601:surgery; D008875:Middle Aged; D010388:Pelvis / Q000293:injuries; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors