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Purpose <p>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.</p> Methods <p>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.</p> Results <p>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.</p> Conclusion <p>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.</p>

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Timing of fracture fixation for femur and pelvis fractures in patients with severe traumatic brain injury - an analysis of the TraumaRegister DGU®

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月22日

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  • Tobias Peter Bayer,
  • Michel P. J. Teuben,
  • Sascha Halvachizadeh,
  • Alba Shehu,
  • Rolf Lefering,
  • Roman Pfeifer,
  • Hans-Christoph Pape,
  • Kai Oliver Jensen

摘要

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.