Should lower limb fractures be treated surgically in patients with chronic spinal injuries? Experience in a reference centre

Management of lower limb fractures in patients with spinal cord injuries

“…These results are in concordance with the literature, which reveals that advancements in fixation technology (including fixed angle devices and intramedullary nailing) and technique have resulted in safer operations which result in earlier union, quicker return to functional independence, shorter hospital admissions and lower incidence of complications . Bishop et al .…”

“…However, modern improvements in intramedullary nail design and materials, including the advent of non‐slotted, reamed titanium alloy nails with interlocking screws and retrograde technique have expanded the indications for fixation, allowing for very proximal and distal metaphyseal fractures around the knee to be adequately stabilized . Specific biomechanical properties offered by intramedullary devices such as load sharing, preservation of soft tissue envelopes and greater torsional rigidity are advantageous for fixation in osteoporotic bone, while quicker surgical time and smaller incisions confers benefits of reduced wound complications in SCI patients . Chin et al .…”

“…However, these modalities are labour intensive, require frequent skin checks and can significantly limit daily function and ability to transfer. More recently, with advancement of fixation techniques (including intramedullary nailing and locking plates), there has been greater use of operative intervention …”

Treatment of Lower Extremity Fractures in Chronic Spinal Cord Injury: A Systematic Review of the Literature

“…Few studies consider functional outcomes, symptom burden, and patient‐reported quality of life in their evaluations of treatment strategies. In those studies that did consider such outcomes, favorable results were noted in terms of patient‐reported quality of life, functional outcomes, including wheelchair mobility and return to prefracture activity, as well as clinical ROM of affected joints in those managed surgically 29‐32 . A high degree of patient satisfaction with surgery was also reported in one study 30 .…”

“…Barrera‐Ochoa et al found that four individuals managed nonoperatively reported reduced quality of life because of pain and autonomic dysreflexia whereas in their surgical cohort there was no loss of function affecting activities of daily living, no limb shortening >1 cm, and no deformity that hindered sitting or wheelchair use. Those managed surgically had a significantly better range of motion (ROM) 30 . Similarly, another case series of operatively managed femoral shaft and supracondylar femur fractures noted that hip and knee ROM was maintained in the surgical extremity compared to the unaffected side 31 .…”