TY - JOUR
T1 - The association of reamed intramedullary nailing and long-term cognitive impairment
AU - Richards, Justin E.
AU - Guillamondegui, Oscar D.
AU - Archer, Kristin R.
AU - Jackson, James C.
AU - Ely, E. Wesley
AU - Obremskey, William T.
PY - 2011/12
Y1 - 2011/12
N2 - Objectives: To examine the association of reamed intramedullary nailing (IMN) and long-term cognitive impairment in trauma intensive care unit survivors. Design: Prospective observational cohort. Setting: Academic Level I trauma center. Patients: One hundred seventy-three patients with multiple trauma (Injury Severity Score greater than 15) who presented to a Level I trauma intensive care unit from July 2006 to July 2007 without evidence of intrancranial hemorrhage. Intervention: None. Main Outcome Measure: Twelve-month cognitive impairment defined a priori as two neuropsychological test scores 1.5 standard deviation below the mean or 1 neuropsychologic test score 2 standard deviations below the mean. Results: One hundred eight of 173 patients (62.4%) were evaluated 12 months after injury with a comprehensive battery of neuropsychological tests. There were 18 patients who received a reamed IMN and 14 of 18 (78%) of these patients had cognitive deficit at follow-up. Fracture treatment with a reamed IMN was associated with long-term impairment (27.4% vs 8.2%, P = 0.03). Multivariable logistic regression found that a reamed IMN (odds ratio, 3.2; 95% confidence interval, 0.95-10.9; P = 0.06) was a moderate risk factor for the development of cognitive impairment 12 months after injury after controlling for Injury Severity Score, level of education, intraoperative hypotension, and duration of mechanical ventilation. Conclusions: Fracture fixation with a reamed IMN is moderately associated with cognitive impairment in this cohort of multiple trauma patients without intrancranial hemorrhage at 1 year postinjury. Orthopaedic trauma research should continue to investigate a potential association of acute fracture management and long-term cognitive outcome.
AB - Objectives: To examine the association of reamed intramedullary nailing (IMN) and long-term cognitive impairment in trauma intensive care unit survivors. Design: Prospective observational cohort. Setting: Academic Level I trauma center. Patients: One hundred seventy-three patients with multiple trauma (Injury Severity Score greater than 15) who presented to a Level I trauma intensive care unit from July 2006 to July 2007 without evidence of intrancranial hemorrhage. Intervention: None. Main Outcome Measure: Twelve-month cognitive impairment defined a priori as two neuropsychological test scores 1.5 standard deviation below the mean or 1 neuropsychologic test score 2 standard deviations below the mean. Results: One hundred eight of 173 patients (62.4%) were evaluated 12 months after injury with a comprehensive battery of neuropsychological tests. There were 18 patients who received a reamed IMN and 14 of 18 (78%) of these patients had cognitive deficit at follow-up. Fracture treatment with a reamed IMN was associated with long-term impairment (27.4% vs 8.2%, P = 0.03). Multivariable logistic regression found that a reamed IMN (odds ratio, 3.2; 95% confidence interval, 0.95-10.9; P = 0.06) was a moderate risk factor for the development of cognitive impairment 12 months after injury after controlling for Injury Severity Score, level of education, intraoperative hypotension, and duration of mechanical ventilation. Conclusions: Fracture fixation with a reamed IMN is moderately associated with cognitive impairment in this cohort of multiple trauma patients without intrancranial hemorrhage at 1 year postinjury. Orthopaedic trauma research should continue to investigate a potential association of acute fracture management and long-term cognitive outcome.
KW - Long-bone fracture
KW - Long-term cognitive impairment
KW - Polytrauma
KW - Reamed intramedullary nail
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U2 - 10.1097/BOT.0b013e318225f358
DO - 10.1097/BOT.0b013e318225f358
M3 - Article
C2 - 22089759
AN - SCOPUS:81455140830
SN - 0890-5339
VL - 25
SP - 707
EP - 713
JO - Journal of Orthopaedic Trauma
JF - Journal of Orthopaedic Trauma
IS - 12
ER -