Efficacy and safety of early surgical fixation of fractures in patients with traumatic brain injury: a scoping review
Bibliographic record
Abstract
Background: Traumatic brain injury (TBI) affects approximately 69 million people annually and can often complicate fracture management. A key challenge is determining the optimal timing for oral maxillofacial surgeries (OMFS) or orthopedic surgeries in patients with concomitant TBI. This review synthesizes existing studies to compare the outcomes of early versus delayed surgical intervention, aiming to provide informed clinical guidance for managing these complex cases. Methods: A comprehensive scoping review was conducted on June 30, 2024, using PubMed, Embase, Web of Science, and Cochrane, and covered publications from 1994 to 2024. Keywords included “traumatic brain injury”, “oral and maxillofacial surgery”, “facial fractures”, “orthopedic procedures” and “time factors”. Studies in English that addressed surgical intervention timing in TBI patients with concomitant facial, orthopedic, or rib fractures were included. High-quality studies such as randomized controlled trials, prospective cohort studies, and meta-analyses were prioritized. The scoping synthesis approach was used to collate and interpret findings which were organized into OMFS injuries, orthopedic injuries, and rib fractures. Results: Of the 228 captured studies, our review included 10 studies published between 1998 and 2024, evaluating early versus delayed surgical repair in TBI patients with OMFS, orthopedic injuries, or rib fractures. The primary and secondary outcomes varied widely, with the most common being Glasgow Outcome Scale (GOS) scores, length of stay, and mortality. Results showed that early surgical intervention generally leads to outcomes that are as favorable as, or better than, delayed surgery. Most OMFS studies reported no difference in outcomes based on timing, while one study found increased complications with delayed surgery. Orthopedic injury studies showed no significant differences in neurological outcomes, and rib fracture studies linked early intervention to shorter hospital stays. Overall, early surgery may reduce complications and improve recovery times without compromising neurological outcomes. Conclusions: Early surgical intervention in TBI patients with facial or orthopedic fractures is as feasible and safe as delayed interventions when perioperative risks are properly managed. This finding aligns with orthopedic and trauma research, highlighting that timely surgical management in polytrauma patients with TBI can be beneficial based on individual patient needs and treatment plans.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.058 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.007 | 0.010 |
| Bibliometrics | 0.013 | 0.009 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".