title: Does additional head trauma affect the long-term outcome after upper extremity trauma in multiple traumatized patients: is there an additional effect of traumatic brain injury?
abstract: BACKGROUND
  Musculoskeletal injuries are common in patients with multiple trauma resulting in pain, functional deficits, and disability. Traumatic brain injuries (TBIs) are common in severely injured patients potentially resulting in neurological impairment and permanent disability that would add to that from the musculoskeletal injuries. However, it is unclear to what degree the combination affects impairment.
  
  
  OBJECTIVE
  We therefore asked whether added upper extremity injuries or TBI worsened the functional, psychological, and vocational status in multiple trauma patients.
  
  
  METHODS
  We retrospectively reviewed 281 patients with multiple trauma: 229 with upper extremity injuries but without TBI (Group I), 32 with concomitant upper extremity injuries and TBI (Group II), and 20 with TBI but no upper extremity injuries (Group III). We assessed patients with the Glasgow Outcome Score (GOS), Hannover Score for Polytrauma Outcome, SF-12 (Physical Component Summary Score and Mental Component Summary Score), medical aid requirements, need of psychological support, and vocational living circumstances. The minimum followup was 10 years (median, 17.5 years; range, 10-28 years).
  
  
  RESULTS
  Additional TBI in multiple trauma patients led to reduced function (GOS: Group I: 4.9 ± 0.2, Group II: 4.5 ± 0.7, Group III: 4.5 ± 0.8) resulting in vocational restrictions (job change: Group I: 74%, Group II: 91%, Group III: 90%). The combination of upper extremity and TBIs did not result in worse long-term scores compared with TBI alone.
  
  
  CONCLUSIONS
  Rehabilitation and social reintegration in multiple trauma patients with TBI requires particular emphasis to minimize disability and vocational isolation. Musculoskeletal injuries should not be neglected to ensure the maximum extremity function given the impaired cognitive functions after TBI.
authors: Department of Trauma and Reconstructive Surgery, University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany. handruszkow@ukaachen.de
authors: Hagen
authors: H
authors: Andruszkow
authors: Christian
authors: C
authors: Probst
authors: Orna
authors: O
authors: Grün
authors: Christian
authors: C
authors: Krettek
authors: Frank
authors: F
authors: Hildebrand
mesh_terms: D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000150:complications* / Q000534:rehabilitation; D006259:Craniocerebral Trauma / Q000150:complications* / Q000534:rehabilitation; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D023261:Glasgow Outcome Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications* / Q000534:rehabilitation; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
references: Arch Phys Med Rehabil. 2004 Apr;85(4 Suppl 2):S73-81
references: 15083425
references: J Neurotrauma. 2007 Mar;24(3):435-45
references: 17402850
references: J Trauma. 2000 May;48(5):841-8; discussion 848-50
references: 10823527
references: J Trauma. 2010 Nov;69(5):1243-51
references: 20489671
references: J Trauma. 2011 Jul;71(1):120-7
references: 21045743
references: Brain Inj. 2007 May;21(5):451-5
references: 17522984
references: J Trauma. 2005 Jun;58(6):1175-8
references: 15995466
references: Injury. 2002 Mar;33(2):111-5
references: 11890911
references: J Trauma. 1974 Mar;14(3):187-96
references: 4814394
references: Lancet. 1975 Mar 1;1(7905):480-4
references: 46957
references: Brain Inj. 2008 Jun;22(6):437-49
references: 18465385
references: Arch Phys Med Rehabil. 2012 Jun;93(6):993-9
references: 22502806
references: Soc Sci Med. 1995 Nov;41(10):1359-66
references: 8560303
references: Injury. 2012 Oct;43(10):1662-6
references: 22695320
references: J Neurol Neurosurg Psychiatry. 2011 Aug;82(8):936-41
references: 21217165
references: Brain Inj. 2012;26(11):1315-27
references: 22876980
references: J Orthop Trauma. 2006 Oct;20(9):591-6
references: 17088659
references: Brain Inj. 2011;25(6):551-9
references: 21534733
references: Injury. 2006 Dec;37(12):1197-203
references: 17087960
references: Med Care. 1996 Mar;34(3):220-33
references: 8628042
references: J Trauma. 1976 Nov;16(11):882-5
references: 994270
references: Injury. 2005 Apr;36(4):468-76
references: 15755426
references: J Trauma Acute Care Surg. 2012 Feb;72(2):467-72
references: 22439211
references: J Trauma. 2002 Jun;52(6):1160-8
references: 12045647
references: Disabil Rehabil. 2007 Feb 28;29(4):301-13
references: 17364780
references: J Trauma. 2010 Mar;68(3):706-11
references: 19996800
references: J Bone Joint Surg Am. 2003 Jan;85(1):33-40
references: 12533569
references: Chirurg. 2001 Mar;72(3):312-8
references: 11317454
references: J Trauma. 2010 Sep;69(3):523-30; discussion 530-1
references: 20838121
references: J Trauma. 2009 Aug;67(2):341-8; discussion 348-9
references: 19667888
references: J Clin Epidemiol. 2001 May;54(5):501-10
references: 11337214
references: Injury. 2005 Jan;36(1):169-77
references: 15589937
references: Disabil Rehabil. 2004 Mar 4;26(5):253-61
references: 15200240
references: Acta Anaesthesiol Scand. 2012 Oct;56(9):1163-74
references: 22735047
references: Eur J Epidemiol. 2004;19(8):751-60
references: 15469032
references: Brain Inj. 2007 Sep;21(10):1023-30
references: 17891564