Abstract
Purpose
The purpose of this study was to prospectively evaluate the rehabilitation outcome of children following operative and non-operative stabilisation of long bone fractures sustained in conjunction with an acquired brain injury (ABI).
Materials and Methods
Between 1996 and 2002, children up to 16 years of age who were admitted to the Paediatric Intensive Care Unit (PICU) with an ABI and concomitant tibial or femoral shaft fractures were considered eligible for inclusion. Children who died or were unable to walk before the accident were excluded. All data relating to the sustained injuries, the duration of PICU inpatient stay, the fracture treatment and the functional outcome were collected prospectively. The severity of the injuries was assessed using the Injury Severity Score (ISS) and the Glasgow Coma Score (GCS). The duration of time was taken from admission to reaching rehabilitation milestones; the ability to sit, stand and walk was then assessed. Total duration of hospital inpatient stay and mobility on discharge were also recorded. Operative skeletal stabilisation included external or internal fixation, as well as flexible intramedullary nailing. Statistical analysis was performed using the Mann-Whitney U Test.
Results
From 300 children admitted to the PICU for treatment of ABI, thirty-seven fulfilled the criteria for inclusion into the study. For both groups (operative vs nonoperative treatment) the mean age of patients was 9 years (range 1–15yrs) and the ISS, GCS scores and the mean stay in PICU were similar. There was a total of 21 femoral fractures (11 treated conservatively and 10 operatively) and 16 tibial fractures (7 conservatively and 9 operatively). Overall, the results showed a reduction in the mean time taken to reach all rehabilitation milestones following operative fracture stabilisation when compared to those treated non-operatively. The mean time to sitting was reduced from 27.1 days to 17.8. The mean time to standing was reduced from 50.1 to 35.6 and to walking, from 67.1 to 45.7 days. The Mann-Whitney U Test demonstrated a statistically significant reduced time to walk in the operatively treated group (p<0.05). Due to the small size of the sample group, significant statistical data for the other parameters measured was not evident.
Conclusion
This study was specifically aimed at the short to medium term gains of operative treatment of tibial and femoral fractures in association with ABI. It has been shown that a co-ordinated rehabilitation programme plus operative stabilisation of children's tibial and femoral shaft fractures sustained in association with ABI, hastens rehabilitation, as it allowed aggressive rehabilitation programme to commence at a much earlier stage without risk of loss of fracture reduction.
