Early vs Late Fixation of Extremity Fractures Among Adults With Traumatic Brain Injury
Authors: Zheng Jiang , Ouyang Yufang , Zhang Ke , Wang Zhixing , Younsi Alexander , Alhalabi Obada , Fu Hong ,   Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) Investigators and Participants, Rosand Jonathan , Correia Marta , Gagliardo Pablo , Vespa Paul M. , Stevens Robert , Furmanov Alex , Brazinova Alexandra , Ghuysen Alexandre , Lagares Alfonso , Kowark Ana , Castaño-León Ana M. , Negru Ancuta , Radoi Andreea , Piippo-Karjalainen Anna , Antoni Anna , Belli Antonio , Ragauskas Arminas , Chieregato Arturo , Lejeune Aurelie , Depreitere Bart , Bellander Bo-Michael , Jacobs Bram , Brorsson Camilla , McMahon Catherine , Rosenlund Christina , Tolias Christos , Dahyot‑Fizelier Claire , Martino Costanza , Tudora Cristina Maria , Kondziella Daniel , Đilvesi Đula , Valeinis Egils , Schwendenwein Elisabeth , Vega Emmanuel , Johnson Faye , Grossi Francesca , Della Corte Francesco , Audibert Gérard , Chevallard Giorgio , Carbayo Lozano Guillermo , Schoonman Guus , Rosenthal Guy , Dulière Guy_x001E_-Loup , Clusmann Hans , Ples Horia , den Boogert Hugo , Maréchal Hugues , Haitsma Iain , Golubovic Jagoš , Payen Jean_x001E_-François , Rhodes Jonathan , van der Naalt Joukje , Sahuquillo Juan , Koskinen Lars_x001E_-Owe  , Giga Lelde , Levi Leon , Beretta Luigi , Rambadagalla Malinka , Azzolini Maria Luisa , Calvi Maria Rosa , Coburn Mark Steven , Thomas Matt , Karan Mladen , Sundström Nina , Barzó Pál , Persona Paolo , Dark Paul , Gomez Pedro A. , Vulekovic Petar , Vajkoczy Peter , Raj Rahul , Helbok Raimund , Vilcinis Rimantas , Lightfoot Roger , Bartels Ronald , Beer Ronny , Rossi Sandra , Rocka Saulius , Frisvold Shirin , Cavallo Simona , Jankowski Stefan , Tamosuitis Tomas , Skandsen Toril , Zelinkova Veronika , Vámos Zoltán , Theadom Alice , Čović Amra , Mikolic Ana , Melegh Béla , Glocker Ben , Gravesteijn Benjamin , Ao Braden Te , van Heugten Caroline , Sewalt Charlie , Nieboer Daan , Pisica Dana , Rueckert Daniel , Voormolen Daphne , Tibboel Dick , Donoghue Emma , Stamatakis Emmanuel , van Veen Ernest , Kompanje Erwin , Wiegers Eveline , Zeiler Frederick A. , Manley Geoffrey , Van der Steen Gregory , Gao Guoyi , Williams Guy , Dawes Helen , Helmrich Isabel Retel , Verheyden Jan , Sandor Janos , Rosenfeld Jeffrey V. , Huijben Jilske , Jiang Ji_x001E_-yao , Brooker Joanne , Gratz Johannes , Haagsma Juanita A. , Jones Kelly , Wang Kevin K.W. , Velt Kimberley , Horton Lindsay , Wilson Lindsay , Maegele Marc , Majdan Marek , Timmers Marjolein , Taylor Mark Steven , Rusnák Martin , Oresic Matej , van der Jagt Mathieu , Pirinen Matti , Jarrett Mike , Schäfer Nadine , Perera Natascha , Curry Nicola , von Steinbüchel Nicole , Esser Patrick , Bragge Peter , Cameron Peter , Ylén Peter , Azouvi Philippe , George Pradeep , Lefering Rolf , Beauvais Romuald , Ripatti Samuli , Stanworth Simon , Polinder Suzanne , Richardson Sylvia , Feigin Valery L. , Rehorčíková Veronika , Brinck Vibeke , Stewart William , Van Hecke Wim , Yang Zhihui , Sorinola Abayomi , Dixit Abhishek , Vargiolu Alessia , Caccioppola Alessio , Buki Andras , Unterberg Andreas , Kolias Angelos G. , Ercole Ari , Thibaut Aurore , Misset Benoit , Roe Cecilie , Galanaud Damien , Whitehouse Daniel , Nelson David , Ledoux Didier , Van Praag Dominique , Helseth Eirik , Calappi Emiliana , Czeiter Endre , Ezer Erzsébet , Kornaropoulos Evgenios , Ortolano Fabrizio , Benali Habib , Adams Hadie , van Erp Inge A.M. , Cooper Jamie D. , Dreier Jens , van Dijck Jeroen T.J.M. , Coles Jonathan , Nyirádi József , Posti Jussi P. , Foks Kelly , Lanyon Linda , Puybasset Louis , Carbonara Marco , Czosnyka Marek , Fabricius Martin , Blaabjerg Morten , Kovács Noémi , Tenovuo Olli , Olubukola Otesile , Parizel Paul M. , Smielewski Peter , Hutchinson Peter J. , Singh Ranjit D. , Sanchez_x001E_-Porras Renan , Schou Rico Frederik , Takala Riikka , van Wijk Roel P. J. , Richter Sophie , Wolf Stefan , Laureys Steven , Vande Vyvere Thijs , van Essen Thomas A. , Menovsky Tomas , Zoerle Tommaso , De Keyser Véronique , Volovici Victor , Tamás Viktória , Degos Vincent , Perlbarg Vincent , Newcombe Virginia , Sakowitz Oliver , Palotie Aarno , Roise Olav , Maas Andrew I.R. , Schoechl Herbert , Cabeleira Manuel , Bullinger Monika , Gruen Russell L. , Gupta Deepak , Rossaint Rolf , Ziverte Agate , Manara Alex , Pomposo Inigo , Berardino Maurizio , Mattern Julia , Schmidt Silke , Legrand Valerie , Muraleedharan Visakh , Anke Audny , Åkerlund Cecilia , Amrein Krisztina , Andreassen Lasse , Andelic Nada , Menon David , Stocchetti Nino , Peul Wilco , Lecky Fiona , Citerio Giuseppe , Steyerberg Ewout W. , Lingsma Hester , Gantner Dashiell , Murray Lynnette , Vallance Shirley , Trapani Tony , Vik Anne , Winzeck Stefan 
Published: March 2024

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.