Timing of extremity fracture fixation does not affect functional outcomes in patients with TBI

In patients with traumatic brain injury (TBI) who sustained extremity fractures, fracture fixation performed within 24 hours after TBI does not appear to result in worse functional outcomes as opposed to when performed beyond 24 hours, according to a study.

For the study, data were obtained from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. A total of 253 patients aged 16 years or older with TBI who underwent internal extremity fixation were identified and included in the analysis. The median age of the study population was 41 years, and 72.7 percent of patients were male.

The median Injury Severity Score (ISS) at baseline was 41. TBI was mild in roughly half of the patients (48.2 percent) and moderate-to-severe in 47.4 percent. There were 74 patients (29.2 percent) who underwent an internal extremity fixation within 24 hours (early), while 179 (70.8 percent) had the procedure 24 hours or later (late).

The primary outcome of an unfavourable functional status at 6 months (Glasgow Outcome Scale–Extended [GOSE] score ≤4) was documented in 86 patients (34.0 percent).

Propensity score-matching analysis showed no significant differences in the odds of unfavourable functional outcomes at 6 months between patients who underwent early extremity fixation and those who underwent late extremity fixation (odds ratio [OR], 1.12, 95 percent confidence interval [CI], 0.51–1.99; p=0.77). Results were consistent in the subgroup of patients with mild TBI (OR, 0.71, 95 percent CI, 0.22–2.29; p=0.56) and the subgroup of those with moderate-to-severe TBI (OR, 1.08, 95 percent CI, 0.32–3.70; p=0.90).

The present data suggest that early fixation after TBI may be considered in patients with mild head injuries.