A retrospective study was performed to assess the effects on outcome of early osteosynthesis of major extremity fractures in patients with severe brain injury (GCS less than or equal to 7). In a consecutive series of 58 patients, early osteosynthesis was performed on the day of injury in 15 patients. (Group A). In 43 patients no major fractures were present or no early osteosynthesis was performed (Group B). The severity of brain injury as seen on CT scan was similar in both groups. Mortality was significantly lower in Group A, despite a significantly higher ISS. As to the functional end result of brain injury, an indication of a better outcome was present in Group A.