European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2026
Timing of fracture fixation for femur and pelvis fractures in patients with severe traumatic brain injury - an analysis of the TraumaRegister DGU®.
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Bayer Tobias Peter, Teuben Michel P J, Halvachizadeh Sascha, Shehu Alba, Lefering Rolf, Pfeifer Roman, Pape Hans-Christoph, Jensen Kai Oliver
Аннотация
PURPOSE: Fracture fixation timing and strategy in polytrauma patients with traumatic brain injury (TBI) remain controversial. This study investigates treatment patterns and outcomes for femoral and/or pelvic fractures stratified by TBI severity.
METHODS: Patients in the TraumaRegister DGU® (2016-2022) with pelvic and/or femoral fractures (AIS ≥3) and TBI (head AIS ≥3) were included. Strategies were non-operative management (NOM), early total care (ETC), and damage-control orthopedics (DCO). Outcomes included treatment allocation, fixation timing, and in-hospital mortality.
RESULTS: 985 patients were included (mean age 52.5, SD 26.3 years; ISS 27.8, SD 8.1). Allocation was NOM in 320 (32.5%), ETC in 336 (34.1%), and DCO in 329 (33.4%) patients. Head AIS was 3 in 48.5%, 4 in 31.1%, and 5 in 20.3%. NOM patients were older, had the highest ISS and estimated mortality, and showed the largest proportion of critical TBI (AIS 5: NOM 30.9%, ETC 14.3%, DCO 16.1%). Femoral ETC was mainly performed within the first day (median 0, IQR 0-1 days), whereas pelvic ETC was delayed with increasing TBI severity (median 3, IQR 0-5 days for head AIS 3; 5, IQR 0-7 days for AIS 4). Observed mortality was 37.2% after NOM, 9.2% after ETC, and 10.3% after DCO.
CONCLUSION: ETC in patients with moderate TBI (AIS 3) was associated with reduced observed mortality relative to NOM and matching DCO. Increasing TBI severity shifted practice patterns to DCO/NOM. These findings suggest that critical head injuries may prolong time to definitive fixation being associated with higher morbidity and mortality.
METHODS: Patients in the TraumaRegister DGU® (2016-2022) with pelvic and/or femoral fractures (AIS ≥3) and TBI (head AIS ≥3) were included. Strategies were non-operative management (NOM), early total care (ETC), and damage-control orthopedics (DCO). Outcomes included treatment allocation, fixation timing, and in-hospital mortality.
RESULTS: 985 patients were included (mean age 52.5, SD 26.3 years; ISS 27.8, SD 8.1). Allocation was NOM in 320 (32.5%), ETC in 336 (34.1%), and DCO in 329 (33.4%) patients. Head AIS was 3 in 48.5%, 4 in 31.1%, and 5 in 20.3%. NOM patients were older, had the highest ISS and estimated mortality, and showed the largest proportion of critical TBI (AIS 5: NOM 30.9%, ETC 14.3%, DCO 16.1%). Femoral ETC was mainly performed within the first day (median 0, IQR 0-1 days), whereas pelvic ETC was delayed with increasing TBI severity (median 3, IQR 0-5 days for head AIS 3; 5, IQR 0-7 days for AIS 4). Observed mortality was 37.2% after NOM, 9.2% after ETC, and 10.3% after DCO.
CONCLUSION: ETC in patients with moderate TBI (AIS 3) was associated with reduced observed mortality relative to NOM and matching DCO. Increasing TBI severity shifted practice patterns to DCO/NOM. These findings suggest that critical head injuries may prolong time to definitive fixation being associated with higher morbidity and mortality.