Safety and efficacy of damage control external fixation versus early definitive stabilization for femoral shaft fractures in the multiple-injured patient.

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Abstract

[Indexed for MEDLINE] 9. J Clin Med. 2023 May 31;12(11):3802. doi: 10.3390/jcm12113802. Impact of a Femoral Fracture on Outcome after Traumatic Brain Injury-A Matched-Pair Analysis of the TraumaRegister DGU(®). Paul MM(1)(2)(3), Mieden HJ(1), Lefering R(4), Kupczyk EK(1), Jordan MC(1), Gilbert F(5), Meffert RH(1), Sirén AL(2)(3), Hoelscher-Doht S(1). Author information: (1)Department of Orthopedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Würzburg, 97080 Würzburg, Germany. (2)Department of Neurophysiology, Institute for Physiology, Julius-Maximilians-University Würzburg, 97070 Würzburg, Germany. (3)Department of Neurosurgery, University Hospital of Würzburg, 97080 Würzburg, Germany. (4)Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, 51109 Cologne, Germany. (5)LMU Klinikum Campus Innenstadt, University of München, 80336 Munich, Germany. Traumatic brain injury (TBI) is the leading cause of death and disability in polytrauma and is often accompanied by concomitant injuries. We conducted a retrospective matched-pair analysis of data from a 10-year period from the multicenter database TraumaRegister DGU® to analyze the impact of a concomitant femoral fracture on the outcome of TBI patients. A total of 4508 patients with moderate to critical TBI were included and matched by severity of TBI, American Society of Anesthesiologists (ASA) risk classification, initial Glasgow Coma Scale (GCS), age, and sex. Patients who suffered combined TBI and femoral fracture showed increased mortality and worse outcome at the time of discharge, a higher chance of multi-organ failure, and a rate of neurosurgical intervention. Especially those with moderate TBI showed enhanced in-hospital mortality when presenting with a concomitant femoral fracture (p = 0.037). The choice of fracture treatment (damage control orthopedics vs. early total care) did not impact mortality. In summary, patients with combined TBI and femoral fracture have higher mortality, more in-hospital complications, an increased need for neurosurgical intervention, and inferior outcome compared to patients with TBI solely. More investigations are needed to decipher the pathophysiological consequences of a long-bone fracture on the outcome after TBI. DOI: 10.3390/jcm12113802 PMCID: PMC10253310