Early fixation of lower-extremity long bone fractures in patients with severe head injury prevents progressive oxygenation deterioration

Abstract

If patients with lower-extremity long bone fractures and severe head injury are treated with lower-extremity traction, they must remain in the supine position for long periods, and their oxygenation may worsen due to atelectasis, pneumonia, or other conditions. We studied whether early fixation of lower-extremity long bone fractures in patients with severe head injury prevents progressive oxygenation deterioration. The study comprised 228 patients requiring traction for lower-extremity long bone fracture fixation who were admitted to our center from April, 1991 through March, 2007. Of these patients, 34 had severe head injury (Abbreviated Injury Scale (AIS) ≥ 3) but did not suffer additional severe injury (AIS ≥ 3) to the thorax or abdomen. Patients who underwent fracture fixation from 24 hours to 5 days after their accident, patients in whom an arterial blood gas measurement was not obtained at day 5, and patients who were treated with hypothermia were excluded, leaving 18 patients for review. Patients were divided into two groups according to time of fracture fixation: early fracture fixation (EFF), occurring within the first 24 hours after the patient's accident (n = 8), and late fracture fixation (LFF), occurring after day 6 following the accident (n = 10). We compared PaO₂/F_IO₂ ratio (P/F ratio) at days 1 and 5 between the two groups and within each group. No differences were found between groups in regard to age, Injury Severity Score, and head AIS and lower-extremity AIS. The average P/F ratio of the EFF group was 453.3 ± 56.6 mmHg at day 1 and 405.9 ± 52.7 mmHg at day 5. The average P/F ratio of the LFF group was 408.4 ± 71.9 mmHg at day 1 and 305.1 ± 104.6 mmHg at day 5. Although the difference in P/F ratio between groups at day 1 was not statistically significant, the difference in P/F ratio at day 5 was statistically significant (p<0.05). In addition, although there was no significant difference in P/F ratio at days 1 and 5 in the EFF group, the difference in P/F ratio at days 1 and 5 in the LFF group was statistically significant (p<0.05). No deaths occurred in either group. We concluded that early fixation of lower-extremity long bone fractures in patients with severe head injury may prevent progressive oxygenation deterioration.