The association of reamed intramedullary nailing and long-term cognitive impairment

J Orthop Trauma. 2011 Dec;25(12):707-13. doi: 10.1097/BOT.0b013e318225f358.


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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Bone Nails*
  • Cognition Disorders / etiology*
  • Cohort Studies
  • Female
  • Fracture Fixation, Intramedullary* / adverse effects
  • Fracture Fixation, Intramedullary* / instrumentation
  • Fracture Fixation, Intramedullary* / methods
  • Fractures, Bone / psychology
  • Fractures, Bone / surgery*
  • Hospitals, Teaching
  • Humans
  • Injury Severity Score
  • Male
  • Multiple Trauma / psychology
  • Multiple Trauma / surgery*
  • Neuropsychological Tests
  • Postoperative Complications
  • Prospective Studies
  • Trauma Centers