Early fracture fixation may be "just fine" after head injury: No difference in central nervous system outcomes

Background: Recent reports suggest that early fracture fixation worsens cen tral nervous system (CNS) outcomes. We compared discharge Glasgow Coma Scal e (GCS) scores, CNS complications, and mortality of severely injured adults with head injuries and pelvic/lower extremity fractures treated with early versus delayed fixation, Methods: Using trauma registry data, records meeting preselected inclusion criteria from the years 1991 to 1995 were examined, We identified 171 patie nts aged 14 to 65 years (mean age, 32.7 years) with head injuries and fract ures who underwent early fixation (less than or equal to 24 hours after adm ission) (n = 147) versus delayed fixation (>24 hours after admission) (n = 24), Results: Patients were severely injured, with a mean admission GCS score of 9.1, Revised Trauma Score of 6.2, Injury Severity Score of 38, median inte nsive care unit length of stay of 16.5 days, and hospital length of stay of 23 days, No differences between groups were found by age, admission GCS sc ore,Injury Severity Score, Revised Trauma Score, intensive care unit length of stay, hospital length of stay, shock, vasopressors, major nonorthopedic operative procedures, total intravenous fluids or blood products, or morta lity rates. In survivors, no differences in discharge GCS scores or CNS com plications were found. Conclusion: We found no evidence to suggest that early fracture fixation ne gatively influences CNS outcomes or mortality.