School of Medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan.
Division of Trauma, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Injury. 2023 Jul;54(7):110804. doi: 10.1016/j.injury.2023.05.035. Epub 2023 May 12.
Early definite treatment for orthopedic patients is strongly advocated. However, a consensus has not been reached on the optimal timing of long bone fracture fixation for patients with associated mild traumatic brain injury (TBI). Surgeons lack evidence on the basis on which they should decide on the operation timing.
We retrospectively reviewed the data of patients with mild TBI and lower extremity long bone fractures from 2010 to 2020. The patients receiving internal fixation within and after 24 h were defined as the early- and delayed-fixation groups. We compared the discharge Glasgow Coma Scale (GCS) scores, lengths of stay, and in-hospital complications. Propensity score matching (PSM) with multiple adjusted variables and a 1:1 matching ratio was applied to reduce selection bias.
In total, 181 patients were enrolled; 78 (43.1%) and 103 (56.9%) patients received early and delayed fracture fixation, respectively. After matching, each group had 61 participants and were statistically identical. The delayed group did not have better discharge GCS scores (early vs. delayed: 15.0 ± 0 vs. 15.0 ± 0.1; p = 0.158). The groups did not differ in their lengths of hospital stay (15.3 ± 10.6 vs. 14.8 ± 7.9; p = 0.789), intensive care unit stay (2.7 ± 4.3 vs. 2.7 ± 3.8; p = 0.947), or incidence of complications (23.0% vs. 16.4%; p = 0.494).
Delayed fixation for patients with lower extremity long bone fractures concurrent with mild TBI does not result in fewer complications or improved neurologic outcomes compared with early fixation. Delaying fixation may not be necessary to prevent the second hit phenomenon and has not demonstrated any clear benefits.
强烈提倡对骨科患者进行早期确定性治疗。然而，对于伴有轻度创伤性脑损伤（TBI）的患者，长骨骨折固定的最佳时机尚未达成共识。外科医生缺乏应据此决定手术时机的依据。
我们回顾性分析了 2010 年至 2020 年患有轻度 TBI 和下肢长骨骨折的患者数据。在 24 小时内和之后接受内固定的患者分别定义为早期和延迟固定组。我们比较了出院格拉斯哥昏迷量表（GCS）评分、住院时间和院内并发症。应用具有多个调整变量的倾向评分匹配（PSM）和 1:1 匹配比来减少选择偏差。
共有 181 名患者入组；78 名（43.1%）和 103 名（56.9%）患者分别接受了早期和延迟骨折固定。匹配后，每组各有 61 名参与者，统计学上无差异。延迟组的出院 GCS 评分无改善（早期与延迟：15.0±0 与 15.0±0.1；p=0.158）。两组的住院时间（15.3±10.6 与 14.8±7.9；p=0.789）、重症监护病房停留时间（2.7±4.3 与 2.7±3.8；p=0.947）或并发症发生率（23.0%与 16.4%；p=0.494）均无差异。
与早期固定相比，伴有轻度 TBI 的下肢长骨骨折患者延迟固定不会导致并发症减少或神经功能结局改善。延迟固定可能没有必要预防二次打击现象，也没有显示出任何明显的益处。
