title: The association of reamed intramedullary nailing and long-term cognitive impairment.
abstract: OBJECTIVE
  To examine the association of reamed intramedullary nailing (IMN) and long-term cognitive impairment in trauma intensive care unit survivors.
  
  
  METHODS
  Prospective observational cohort.
  
  
  METHODS
  Academic Level I trauma center.
  
  
  METHODS
  One hundred seventy-three patients with multiple trauma (Injury Severity Score greater than 15) who presented to a Level I trauma intensive care unit from July 2006 to July 2007 without evidence of intrancranial hemorrhage.
  
  
  METHODS
  None.
  
  
  METHODS
  Twelve-month cognitive impairment defined a priori as two neuropsychological test scores 1.5 standard deviation below the mean or 1 neuropsychologic test score 2 standard deviations below the mean.
  
  
  RESULTS
  One hundred eight of 173 patients (62.4%) were evaluated 12 months after injury with a comprehensive battery of neuropsychological tests. There were 18 patients who received a reamed IMN and 14 of 18 (78%) of these patients had cognitive deficit at follow-up. Fracture treatment with a reamed IMN was associated with long-term impairment (27.4% vs 8.2%, P = 0.03). Multivariable logistic regression found that a reamed IMN (odds ratio, 3.2; 95% confidence interval, 0.95-10.9; P = 0.06) was a moderate risk factor for the development of cognitive impairment 12 months after injury after controlling for Injury Severity Score, level of education, intraoperative hypotension, and duration of mechanical ventilation.
  
  
  CONCLUSIONS
  Fracture fixation with a reamed IMN is moderately associated with cognitive impairment in this cohort of multiple trauma patients without intrancranial hemorrhage at 1 year postinjury. Orthopaedic trauma research should continue to investigate a potential association of acute fracture management and long-term cognitive outcome.
authors.affiliation: Division of Orthopaedic Trauma, Vanderbilt Orthopaedic Institute, Nashville, TN, USA.
authors.forename: Justin E
authors.initials: JE
authors.lastname: Richards
authors.forename: Oscar D
authors.initials: OD
authors.lastname: Guillamondegui
authors.forename: Kristin R
authors.initials: KR
authors.lastname: Archer
authors.forename: James C
authors.initials: JC
authors.lastname: Jackson
authors.forename: E Wesley
authors.initials: EW
authors.lastname: Ely
authors.forename: William T
authors.initials: WT
authors.lastname: Obremskey
mesh_terms: D000328:Adult; D001858:Bone Nails; D003072:Cognition Disorders / Q000209:etiology*; D015331:Cohort Studies; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D050723:Fractures, Bone / Q000523:psychology / Q000601:surgery*; D006784:Hospitals, Teaching; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D009104:Multiple Trauma / Q000523:psychology / Q000601:surgery*; D009483:Neuropsychological Tests; D011183:Postoperative Complications; D011446:Prospective Studies; D014193:Trauma Centers
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