Early fracture fixation may be deleterious after head injury

Russell R. Jaicks, Stephen M. Cohn, Beth A. Moller

Research output: Contribution to journalArticle

139 Scopus citations

Abstract

Objective: To determine the neurologic risks associated with early fracture fixation (FF) in multitrauma patients with head injuries. Methods: We reviewed 33 blunt trauma patients with significant closed head injuries (Abbreviated Injury Scale (AIS) score ≤ 2) requiring operative FF. Nineteen patients underwent early FF defined as ≤ 24 hours after injury, and 14 patients underwent late FF defined as >24 hours after injury. The two groups were well matched in regards to age, 40.3 years (range, 8-88 years) versus 36.4 years (range, 8-75 years), admission Glasgow Coma Scale score (12 ± 4 vs. 11 ± 5), and Injury Severity Score (25 ± 10 vs. 27 ± 12). Additionally, the groups had similar neurologic and orthopedic injury scores (AIS-CNS score = 3.3 ± 0.9 vs. 3.1 ± 0.9, AIS-Ortho score = 3.0 ± 0.9 vs. 2.9 ± 0.7). Data were collected concerning the volume of fluid resuscitation, neurologic complications, and clinical outcomes. Results: The early FF group received significantly more fluids in the first 48 hours (14.0 ± 10.2 vs. 8.7 ± 3.5 liters, p < 0.05). The early group trended towards a higher rate of intraoperative hypotension (systolic blood pressure < 90 mm Hg, 16% vs. 7%) and intraoperative hypoxia (02-Saturation ≤ 90, 11% vs. 7%). The neurologic complication rate was similar in the two groups (early FF = 16% vs. late FF = 21%), but the average discharge Glasgow Coma Scale score was lower in the early group (13.5 ± 3.7) when compared with the late FF patient group (15.0 ± 0.9). Conclusions: Early FF leads to greater fluid administration in patients with head injuries. Hypoxemia and hypotension, risk factors for secondary brain injury, may contribute to a poor neurologic outcome after early fixation. Prospective studies evaluating the impact of the timing of FF on head injury are indicated.

Original languageEnglish (US)
Pages (from-to)1-6
Number of pages6
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume42
Issue number1
DOIs
StatePublished - Jan 1 1997

Keywords

  • Fracture fixation
  • Head trauma
  • Secondary brain injury

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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