• Shan Lu, Tianjiao Du, Zhiming Sun, Lixia Xu, Xiaoguang Tong, and Hua Yan.
• Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgical Institute, Tianjin Huanhu Hospital, Tianjin, China.
• World Neurosurg. 2020 Jan 1; 133: 227-236.

BackgroundTraumatic brain injury (TBI) is a common public health problem. The optimal timing of fracture fixation in patients with TBI has remained controversial. We conducted a meta-analysis to quantitatively discuss the effects of fixation timing on the prognosis of patients with extremity fracture and concomitant TBI.MethodsA systematic search was performed in PubMed, EMBASE, the Cochrane Library and 4 Chinese databases from the inception date to May 19, 2019. Randomized controlled trials and cohort studies comparing early and late fracture fixation in adults with TBI concomitant with extremity fractures were selected. The risk ratio (RR) and standardized mean difference were calculated.ResultsA total of 14 cohort studies involving 1046 patients fulfilled our criteria. No statistically significant association was found between fixation timing and mortality rate (RR, 1.34; 95% confidence interval [CI], 0.89-2.01). No significant association was found between fracture fixation timing and the incidence of death among the patients with severe TBI (RR, 1.82; 95% CI, 0.50-6.66), moderate or more serious TBI (RR, 3.78; 95% CI, 0.53-26.78), and unrestricted TBI type (RR, 0.80; 95% CI, 0.38-1.68). No significant association was found between fracture fixation timing and neurologic complications (RR, 0.71; 95% CI, 0.45-1.11). When the cutoff for fixation timing was set at 14 days, the incidence of nonunion or malunion in the earlier fixation group was lower than that in the later fixation group (RR, 0.39; 95% CI, 0.17-0.91).ConclusionLate fracture fixation conducted >14 days after injury was associated with nonunion or malunion. Fixation performed within 24 hours did not influence mortality or adverse neurologic events.Copyright © 2019 Elsevier Inc. All rights reserved.

16 keywords...

hide…