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 t o determine whether the timing of fracture fixation is correlated to n eurologic outcome. Methods. We retrospectively reviewed patients with severe head and orthopedic injuries requiring fracture fixation. Patie nts were divided into two groups: early fracture fixation (<24 hours a fter injury) and late fracture fixation (>24 hours after injury). Resu lts. One hundred twenty-three patients met entry criteria. During frac ture fixation, the early group had a significant 2-, 3-, and 2-fold in crease in crystalloid, blood infusion, and blood loss, respectively. T here was no difference in oxygen saturation and systolic blood pressur e or episodes of cranial hypertension or hypoperfusion. There was no d ifference in outcomes as measured by in-hospital complications, stay i n the intensive care unit or hospital, mortality rates, hospital disch arge or follow-up Glasgow Coma Scores, or long-term orthopedic or neur ologic results. Conclusions. Patients undergoing fracture fixation wit h severe head injury mandate monitoring of intracranial pressure and p erfusion and tailored fluid resuscitation to meet specific organ end p oints. integrating end organ perfusion and pressure with meticulous fl uid status during the definitive repair phase may reduce the exposure to secondary brain injury in patients undergoing early fracture fixati on.