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

Justin E. Richards, Oscar D. Guillamondegui, Kristin R. Archer, James C. Jackson, E. Wesley Ely, William T. Obremskey

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)707-713
Number of pages7
JournalJournal of Orthopaedic Trauma
Issue number12
StatePublished - Dec 2011
Externally publishedYes


  • Long-bone fracture
  • Long-term cognitive impairment
  • Polytrauma
  • Reamed intramedullary nail

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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