Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Mar 4;7(3):e241556.
doi: 10.1001/jamanetworkopen.2024.1556.

Early vs Late Fixation of Extremity Fractures Among Adults With Traumatic Brain Injury

Jiang Zheng  1 , Yufang Ouyang  1 , Ke Zhang  1 , Zhixing Wang  1 , Alexander Younsi  2 , Obada Alhalabi  2 , Hong Fu  1 ; Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) Investigators and Participants
Collaborators, Affiliations

Early vs Late Fixation of Extremity Fractures Among Adults With Traumatic Brain Injury

Jiang Zheng et al. JAMA Netw Open. .

Abstract

Importance: The optimal timing for fixation of extremity fractures after traumatic brain injury (TBI) remains controversial.

Objective: To investigate whether patients who underwent extremity fixation within 24 hours of TBI experienced worse outcomes than those who had the procedure 24 hours or more after TBI.

Design, setting, and participants: This cohort study used data from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. Patients 16 years or older with TBI who underwent internal extremity fixation met inclusion criteria. To compare outcomes, patients who underwent the procedure within 24 hours were propensity score matched with those who underwent it 24 hours or later. Patients were treated from December 9, 2014, to December 17, 2017. Data analysis was conducted between August 1, 2022, and December 25, 2023.

Main outcomes and measures: The primary outcome was an unfavorable functional status at 6 months (Glasgow Outcome Scale-Extended [GOSE] score ≤4).

Results: A total of 253 patients were included in this study. The median age was 41 (IQR, 27-57) years, and 184 patients (72.7%) were male. The median Injury Severity Score (ISS) was 41 (IQR, 27-49). Approximately half of the patients (122 [48.2%]) had a mild TBI while 120 (47.4%) had moderate to severe TBI. Seventy-four patients (29.2%) underwent an internal extremity fixation within 24 hours, while 179 (70.8%) had the procedure 24 hours or later. At 6 months, 86 patients (34.0%) had an unfavorable functional outcome. After propensity score matching, there were no statistically significant differences in unfavorable functional outcomes at 6 months (odds ratio [OR], 1.12 [95% CI, 0.51-1.99]; P = .77) in patients with TBI of any severity. Similar results were observed in patients with mild TBI (OR, 0.71 [95% CI, 0.22-2.29]; P = .56) and moderate to severe TBI (OR, 1.08 [95% CI, 0.32-3.70]; P = .90).

Conclusions and relevance: The outcomes of extremity fracture fixation performed within 24 hours after TBI appear not to be worse than those of procedures performed 24 hours or later. This finding suggests that early fixation after TBI could be considered in patients with mild head injuries.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure.
Figure.. Flow Diagram of Study Population
CENTER-TBI indicates Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury; EEF, early extremity fixation; and LEF, late extremity fixation.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Majdan M, Plancikova D, Brazinova A, et al. . Epidemiology of traumatic brain injuries in Europe: a cross-sectional analysis. Lancet Public Health. 2016;1(2):e76-e83. doi:10.1016/S2468-2667(16)30017-2 - DOI - PubMed
    1. Morshed S, Miclau T III, Bembom O, Cohen M, Knudson MM, Colford JM Jr. Delayed internal fixation of femoral shaft fracture reduces mortality among patients with multisystem trauma. J Bone Joint Surg Am. 2009;91(1):3-13. doi:10.2106/JBJS.H.00338 - DOI - PMC - PubMed
    1. Watanabe T, Kawai Y, Iwamura A, Maegawa N, Fukushima H, Okuchi K. Outcomes after traumatic brain injury with concomitant severe extracranial injuries. Neurol Med Chir (Tokyo). 2018;58(9):393-399. doi:10.2176/nmc.oa.2018-0116 - DOI - PMC - PubMed
    1. Leitgeb J, Mauritz W, Brazinova A, Majdan M, Wilbacher I. Impact of concomitant injuries on outcomes after traumatic brain injury. Arch Orthop Trauma Surg. 2013;133(5):659-668. doi:10.1007/s00402-013-1710-0 - DOI - PMC - PubMed
    1. Flierl MA, Stoneback JW, Beauchamp KM, et al. . Femur shaft fracture fixation in head-injured patients: when is the right time? J Orthop Trauma. 2010;24(2):107-114. doi:10.1097/BOT.0b013e3181b6bdfc - DOI - PubMed

Publication types