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This study investigates treatment patterns and outcomes for femoral and\/or pelvic fractures stratified by TBI severity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients in the TraumaRegister DGU\u00ae (2016\u20132022) with pelvic and\/or femoral fractures (AIS \u22653) and TBI (head AIS \u22653) were included. Strategies were non-operative management (NOM), early total care (ETC), and damage-control orthopedics (DCO). Outcomes included treatment allocation, fixation timing, and in-hospital mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>985 patients were included (mean age 52.5, SD 26.3 years; ISS 27.8, SD 8.1). Allocation was NOM in 320 (32.5%), ETC in 336 (34.1%), and DCO in 329 (33.4%) patients. Head AIS was 3 in 48.5%, 4 in 31.1%, and 5 in 20.3%. NOM patients were older, had the highest ISS and estimated mortality, and showed the largest proportion of critical TBI (AIS 5: NOM 30.9%, ETC 14.3%, DCO 16.1%). Femoral ETC was mainly performed within the first day (median 0, IQR 0-1 days), whereas pelvic ETC was delayed with increasing TBI severity (median 3, IQR 0\u20135 days for head AIS 3; 5, IQR 0\u20137 days for AIS 4). Observed mortality was 37.2% after NOM, 9.2% after ETC, and 10.3% after DCO.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>ETC in patients with moderate TBI (AIS 3) was associated with reduced observed mortality relative to NOM and matching DCO. Increasing TBI severity shifted practice patterns to DCO\/NOM. These findings suggest that critical head injuries may prolong time to definitive fixation being associated with higher morbidity and mortality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00068-026-03253-x","type":"journal-article","created":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T06:58:09Z","timestamp":1782111489000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Timing of fracture fixation for femur and pelvis fractures in patients with severe traumatic brain injury - an analysis of the TraumaRegister DGU\u00ae"],"prefix":"10.1007","volume":"52","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-9628-511X","authenticated-orcid":false,"given":"Tobias Peter","family":"Bayer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michel P. 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