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