Early fixation of extremity fractures may be appropriate for patients with traumatic brain injury

1. In a cohort of patients with traumatic brain injury, early fixation of extremity fractures within 24 hours of injury was not associated with greater rates of unfavourable functional outcomes at 6 months. 

Evidence Rating: 2 (Good) 

While extremity fractures are commonly seen in conjunction with traumatic brain injury (TBI), the ideal timing of fixation and definitive treatment of these fractures remain controversial. On one hand, there are those who argue in favour of earlier fixation to promote a shorter recovery course and decreased complication rates. On the other hand however, there are those that argue that the risk of intraoperative complications as well as postoperative stress may further worsen neurologic outcomes. In this multicenter, longitudinal prospective cohort study, data from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study was used to further characterize this association. Patients aged 16 or older who underwent internal extremity fixation either within 24 hours or later were propensity score matched to assess differences in unfavourable outcomes at 6 months follow-up. The Glasgow Outcome Scale-Extended (GOSE) score was used as the primary outcome to determine long-term functional outcomes, and secondary outcomes included other measures such as mortality, cardiovascular complications, infections, and other adverse outcomes. Amongst the 253 patients included in the study, which included both mild (N=122) and moderate to severe (N=120) TBI, 74 (29.2%) underwent early internal extremity fixation. It was found that at 6 months follow-up, the rates of both primary and secondary outcomes were not statistically significant between the early fixation for TBI of any severity (odds ratio [OR], 1.12 [95% CI, 0.51-1.99]; P = .77), nor when separating mild from moderate to severe TBI. Overall, although the sample size was small, study findings suggest that it may be safe to provide early intervention for extremity fractures in those with TBI, although further research will be required.

Click to read the study in JAMA Network Open

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