PMID: 9003250Jan 1, 1997Paper

Early fracture fixation may be deleterious after head injury

The Journal of Trauma
R R JaicksB A Moller

Abstract

To determine the neurologic risks associated with early fracture fixation (FF) in multitrauma patients with head injuries. We reviewed 33 blunt trauma patients with significant closed head injuries (Abbreviated Injury Scale (AIS) score > or = 2) requiring operative FF. Nineteen patients underwent early FF defined as < or = 24 hours after injury, and 14 patients underwent late FF defined as > 24 hours after injury. The two groups were well matched in regards to age, 40.3 years (range, 8-88 years) versus 36.4 years (range, 8-75 years), admission Glasgow Coma Scale score (12 +/- 4 vs. 11 +/- 5), and Injury Severity Score (25 +/- 10 vs. 27 +/- 12). Additionally, the groups had similar neurologic and orthopedic injury scores (AIS-CNS score = 3.3 +/- 0.9 vs. 3.1 +/- 0.9, AIS-Ortho score = 3.0 +/- 0.9 vs. 2.9 +/- 0.7). Data were collected concerning the volume of fluid resuscitation, neurologic complications, and clinical outcomes. The early FF group received significantly more fluids in the first 48 hours (14.0 +/- 10.2 vs. 8.7 +/- 3.5 liters, p < 0.05). The early group trended towards a higher rate of intraoperative hypotension (systolic blood pressure < 90 mm Hg, 16% vs. 7%) and intraoperative hypoxia (O2-Saturation < or = 90, 11% ...Continue Reading

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