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Timing fracture repair in patients with severe brain injury (Glasgow Coma Scale score <9)
R N Townsend1, T Lheureau, J Protech
1Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.
Background:
Trauma patients with severe brain injury are at risk of secondary brain injury. Femur fractures, if present, should be repaired when potential causes of secondary brain injury have been corrected.
Methods:
Sixty-one patients with severe or moderate closed head injury and femur fractures were identified. Patients were divided into groups by time until femur fracture reduction.
Results:
An inversely proportional trend was demonstrated when comparing time until surgery with the percentage of patients who experienced hypotensive events during surgery. Patients in the 0- to 2-hour group were eight times more likely to become hypotensive during femur repair than patients in the >24-hour group. Seventy-four percent of patients with intracranial pressure monitoring experienced cerebral perfusion pressure <70 mm Hg.
Conclusions:
Operation in similar patients should be done when risks are minimized by adequate resuscitation. Secondary brain injury is more common in early femur repair. Operation delay of 24 hours may be necessary to prevent hypoxia, hypotension, and low cerebral perfusion pressure.