Does lower extremity fracture fixation technique influence neurologic outcomes in patients with traumatic brain injury? The EAST Brain vs. Bone multicenter trial

被引：2

作者：

Ghneim, Mira ^{[1
,36
]}

Kufera, Joseph ^{[2
]}

Zhang, Ashling ^{[3
]}

Penaloza-Villalobos, Liz ^{[4
]}

Swentek, Lourdes ^{[4
]}

Watras, Jill ^{[5
]}

Smith, Alison ^{[6
]}

Hahn, Alexandra ^{[7
]}

Rodriguez Mederos, Dalier ^{[8
]}

Dickhudt, Timothy John ^{[8
]}

Laverick, Paige ^{[9
]}

Cunningham, Kyle ^{[9
]}

Norwood, Scott ^{[10
]}

Fernandez, Luis ^{[10
]}

Jacobson, Lewis E. ^{[11
]}

Williams, Jamie M. ^{[11
]}

Lottenberg, Lawrence ^{[12
]}

Azar, Faris ^{[12
]}

Shillinglaw, William ^{[13
]}

Slivinski, Andrea ^{[13
]}

Nahmias, Jeffry ^{[14
]}

Donnelly, Megan ^{[14
]}

Bala, Miklosh ^{[15
,16
]}

Egodage, Tanya ^{[17
]}

Zhu, Clara ^{[17
]}

Udekwu, Pascal O. ^{[18
]}

Norton, Hannah ^{[18
]}

Dunn, Julie A. ^{[19
]}

Baer, Robert ^{[20
]}

Mcbride, Katherine ^{[21
]}

Santos, Ariel P. ^{[22
]}

Shrestha, Kripa ^{[22
]}

Metzner, Caleb J. ^{[23
]}

Murphy, Jade M. ^{[23
]}

Schroeppel, Thomas J. ^{[24
]}

Stillman, Zachery ^{[24
]}

O'Connor, Rick ^{[25
]}

Johnson, Dirk ^{[25
]}

Berry, Cherisse ^{[26
]}

Ratner, Molly ^{[26
]}

Reynolds, Jessica K. ^{[27
]}

Humphrey, Mackenzie ^{[27
]}

Scott, Mark ^{[28
]}

Hickman, Zachary L. ^{[29
]}

Twelker, Kate ^{[29
]}

Legister, Candice ^{[30
]}

Glass, Nina E. ^{[30
]}

Siebenburgen, Christa ^{[31
]}

Palmer, Brandi ^{[31
]}

Semon, Gregory R. ^{[32
]}

机构：

[1] Univ Maryland, R Adams Cowley Shock Trauma Ctr, Dept Surg, Program Trauma,Sch Med, Baltimore, MD USA

[2] Univ Maryland, Natl Study Ctr Trauma & Emergency Med Syst, Ctr Shock Trauma & Anesthesiol Res, Program Trauma,Sch Med, Baltimore, MD USA

[3] Univ Maryland, Sch Med, Baltimore, MD USA

[4] Loma Linda Univ, Med Ctr, Dept Surg, Loma Linda, CA USA

[5] Inova Fairfax Hosp, Falls Church, VA USA

[6] LSUHCS, New Orleans, LA USA

[7] Ochsner Med Ctr, Jefferson, LA USA

[8] Broward Hlth Med Ctr, Ft Lauderdale, FL USA

[9] Atrium Hlth Carolinas Med Cente, Charlotte, NC USA

[10] Univ Texas Hlth Sci Ctr, Austin, TX USA

[11] Ascens St Vincent Hosp, Indianapolis, IN USA

[12] Florida Atlantic Univ, Schmidt Coll Med, St Marys Med Ctr, Boca Raton, FL USA

[13] Mission Hosp, Asheville, NC USA

[14] Univ Calif Irvine, Irvine, CA USA

[15] Univ Jerusalem, Hadassah Med Ctr, Jerusalem, Israel

[16] Hebrew Univ Jerusalem, Fac Med, Jerusalem, Israel

[17] Cooper Univ Hlth Care, Camden, NJ USA

[18] WakeMed Hlth & Hosp, Raleigh, NC USA

[19] Univ Colorado Hlth North, Med Ctr Rockies, Colorado Springs, CO USA

[20] Orthoped Ctr Rockies, Ft Collins, CO USA

[21] Mem Univ, Med Ctr, Savannah, GA USA

[22] Texas Tech Univ, Hlth Sci Ctr, Lubbock, TX USA

[23] Spartanburg Reg Med Ctr, Spartanburg, SC USA

[24] Mem Hosp Cent, Colorado Springs, CO USA

[25] Yale Sch Med, New Haven, CT USA

[26] NYU Grossman Sch Med, New York, NY USA

[27] Univ Kentucky, Lexington, KY USA

[28] Essentia Hlth, St Marys Med Ctr, Duluth, MN USA

[29] Icahn Sch Med Mt Sinai, NYC Hlth Hosp Elmhurst, New York, NY USA

[30] Rutgers New Jersey Med Sch, Newark, NJ USA

[31] Kettering Hlth Main Campus, Kettering, OH USA

[32] Wright State Univ, Boonshoft Sch Med, Fairborn, OH USA

[33] Tuft Univ, Sch Med, Res Med Ctr, Medford, MA USA

[34] Tuft Univ, Sch Med, Tufts Med Ctr, Medford, MA USA

[35] Tufts Med Ctr, Boston, MA USA

[36] Univ Maryland, Med Ctr, R Adams Cowley Shock Trauma Ctr, Program Trauma,Sch Med, 22 S Greene St, Baltimore, MD 21201 USA

来源：

JOURNAL OF TRAUMA AND ACUTE CARE SURGERY | 2023年 / 95卷 / 04期

关键词：

Traumatic brain injury; long-bone fractures; neurologic outcomes; EXTERNAL FIXATION; FEMUR FRACTURES; MOTOR SCORE; SURGERY; SHAFT;

D O I：

10.1097/TA.0000000000004095

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

OBJECTIVE: This study aimed to determine whether lower extremity fracture fixation technique and timing (<= 24 vs. > 24 hours) impact neurologic outcomes in TBI patients. METHODS: A prospective observational study was conducted across 30 trauma centers. Inclusion criteria were age 18 years and older, head Abbreviated Injury Scale (AIS) score of > 2, and a diaphyseal femur or tibia fracture requiring external fixation (Ex-Fix), intramedullary nailing (IMN), or open reduction and internal fixation (ORIF). The analysis was conducted using analysis of variamce, Kruskal-Wallis, and multivariable regression models. Neurologic outcomes were measured by discharge Ranchos Los Amigos Revised Scale (RLAS-R). RESULTS: Of the 520 patients enrolled, 358 underwent Ex-Fix, IMN, or ORIF as definitive management. Head AIS was similar among cohorts. The Ex-Fix group experienced more severe lower extremity injuries (AIS score, 4-5) compared with the IMN group (16% vs. 3%, p = 0.01) but not theORIF group (16% vs. 6%, p = 0.1). Time to operative intervention varied between the cohortswith the longest time to intervention for the IMN group (median hours: Ex-Fix, 15 [8-24] vs. ORIF, 26 [12-85] vs. IMN, 31 [12-70]; p < 0.001). The discharge RLAS-R score distribution was similar across the groups. After adjusting for confounders, neither method nor timing of lower extremity fixation influenced the discharge RLAS-R. Instead, increasing age and head AIS scoreassociated with a lower discharge RLAS-R score (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.002-1.03 and OR, 2.37; 95% CI, 1.75-3.22), and a higher Glasgow Coma Scale motor score on admission (OR, 0.84; 95% CI, 0.73-0.97) was associated with higher RLAS-R score at discharge. CONCLUSION: Neurologic outcomes in TBI are impacted by severity of the head injury and not the fracture fixation technique or timing. Therefore, the strategy of definitive fixation of lower extremity fractures should be dictated by patient physiology and the anatomy of the injured extremity and not by the concern for worsening neurologic outcomes in TBI patients. (J Trauma Acute Care Surg. 2023;95: 516-523. Copyright (c) 2023 Wolters Kluwer Health, Inc. All rights reserved.)were

引用

页码：516 / 523

页数：8

共 9 条

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WORLD NEUROSURGERY, 2020, 133 : 227 - 236
[2] Initial EEG Predicts Outcomes in a Trial of Levetiracetam vs. Fosphenytoin for Seizure Prevention in Patients with Severe Traumatic Brain Injury
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