Does accelerated bone healing associated with traumatic brain injury (TBI) occur in open fractures

Author(s): Ramesh Perumal, Sivakumar SP, Vijay Shankar, Santosh Ram Gaddam, Dheenadhayalan Jayaramaraju and Shanmuganathan Rajasekaran

Abstract: Aim: Accelerated bone healing has been frequently reported in patients with traumatic brain injury (TBI). However, all these reports are restricted to closed fractures and there is no literature of the effect of TBI in open fractures. Between 2011 and 2013, sixty six patients with TBI of whom thirty four had closed fractures (Group IA) and thirty two had open fractures (Group IIA) were compared with eighty patients without TBI of whom forty had closed fractures (Group IB) and forty had open fractures (Group IIB). The mean duration of follow up was 13 months. Time to fracture union and fracture healing response were compared in both groups. Though group IA patients had shorter time to union (27 weeks) compared to all other groups (IB- 32 weeks, IIA- 36 weeks, IIB-30 weeks), there was no statistical significance between the groups (P>0.05). However, the subset of patients who underwent craniotomy in Group IA (6) had significantly shorter time to healing (24 weeks, P=0.05) compared to other groups. Considering the fracture healing response (FHR), there was no statistical difference between groups. Accelerated callus response from FHR of 1.4 to 1.8 was observed in closed fractures for thirty six weeks, whereas this was seen only for eighteen weeks in open fractures. In our study of 146 patients, the beneficial effect of TBI on fracture healing was restricted to the subset of patients with closed fractures and those requiring craniotomy. There was no beneficial response in patients with open fractures.

DOI: https://doi.org/10.22271/ortho.2018.v4.i2j.99