TIMING OF FRACTURE FIXATION IN BLUNT TRAUMA PATIENTS WITH SEVERE HEAD-INJURIES

BACKGROUND: Early fracture fixation in blunt trauma patients is sugges ted to decrease postoperative morbidity by allowing early mobilization and reducing the release of harmful inflammatory mediators. Some stud ies have challenged this concept in the presence of severe associated injuries, and especially head trauma. METHODS: The records of 47 conse cutive blunt trauma patients with severe head injuries, as defined by a Glasgow Coma Score (GCS) less than or equal to 8 and a head Abbrevia ted Injury Score (AIS) greater than or equal to 3, and long bone fract ures requiring surgical fixation were reviewed. The study population w as divided into the early fixation (EF) group, consisting of 22 patien ts who underwent fracture fixation within 24 hours of admission (mean time 17 +/- 8.5 hours); and the late fixation (LF) group, consisting o f 25 patients, who had orthopedic repair at a later time (mean 143 +/- 178 hours). RESULTS: The two groups were similar in terms of overall injury severity, neurologic injuries, hemodynamic and neurologic statu s on admission, and operations received. patients in the EF group had a higher injury severity of extremity fractures (extremity AIS: 2.9 +/ - 0.2 versus 2.4 +/- 0.5, P = 0.0002) and a higher incidence of open f ractures (72% versus 36%, P = 0.02). There was no difference in intrao perative and postoperative hypoxic and hypotensive episodes. Neurologi c, orthopedic, and general complications were the same between the two groups. The mean GCS on discharge was 12 +/- 3 for both groups with e qual distribution among patients. Although there was a trend toward lo nger hospital stay (25 +/- 17 versus 17 +/- 10 days, P = 0.057) among LF patients, mechanical ventilation days, length of stay, and mortalit y were not different, CONCLUSIONS: Timing of fracture fixation in this group of blunt trauma patients with severe head injuries did not infl uence morbidity, mortality, or neurologic outcome. (C) 1998 by Excerpt a Medica, Inc.