The Management of Long Bone Fracture in the Spinal Cord Injured Patient

Wc, McMaster; Es, Stauffer

doi:10.1097/00003086-197510000-00006

Cited by 26 publications

(34 citation statements)

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“…A pillow or pillows were sometimes secured to the lower limb around the fracture. These have been described in detail (Freehafer & Mast, 1965;McMaster & Stauffer, 1975). Sometimes (especially for proximal femoral fractures) the lower extremities were fixed to a pillow placed between the thighs.…”

Section: Treatment and Resultsmentioning

confidence: 99%

Lower extremity fractures in patients with spinal cord injury

1981

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Abstract. Lower limb fractures occurring in patients with established spinal paralysis were considered different enough to warrant variations in treatment usually provided to patients without paralysis. Treatment should ensure that the functional level will be unchanged after healing occurs. Splints made of soft materials were effective, inexpen sive, safe, and allowed for good healing with early rehabilitation.Key words: Spinal cord injury; Lower extremity fractures; Soft splints.THE RESULTS of a study from this institution on fractures of long bones in patients with spinal cord injury were published by Freehafer and Mast (1965). It becomes mandatory, therefore, to vary the treatment for the paralysed patient rather than to give the same treatments usually provided for the average patient without paralysis.Certain observations were made from our study in 1965 which formed the basis of subsequent treatment from which data for this study were gathered. From this experience the following impressions and recommendations have evolved:I. The functional level should be unchanged after fracture healing.2. Healing of fractures should take place with minimum risk of complications. 3. Non-operative treatment of fractures was recommended as the method leading to the most rapid union, the least number of complications, the quickest rehabilitation and the smallest morbidity rate.4. Patients should be out of bed in wheelchairs as soon as possible or within the first few days after fracture. 5.Traction was rarely indicated. 6. Plaster casts and splints or any hard materials used for immobilisation were potentially dangerous and should be avoided. 7.Open reduction was rarely necessary. Occasionally uncontrollable spas ticity could cause protrusion of bone fragments through the skin necessitating open reduction or simple removal of bony prominences.8. Shortening and angulation of healed fractures were acceptable in sitters, but rotational deformity in a sitter was unacceptable.9. Patients who walked should be treated by conventional methods which give an anatomical result permitting the patient to resume walking at the same functional level.

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Section: Treatment and Resultsmentioning

confidence: 99%

Lower extremity fractures in patients with spinal cord injury

1981

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“…4 From our literature review, 5 ± 10 most studies concerned treatment of long-bone fracture in chronic SCI patients, while only a few articles focused on concurrent fractures or associated injuries in acute SCI patients. These studies, however, were based on small sample sizes.…”

Section: Introductionmentioning

confidence: 99%

Epidemiology of extraspinal fractures associated with acute spinal cord injury

et al. 2001

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Study design: A descriptive study of concurrent extraspinal fractures collected prospectively during initial hospital care. Objectives: To examine the frequency and related characteristics of concurrent extraspinal fractures among patients with a new onset of spinal cord injury (SCI). Setting: Model SCI care systems throughout the United States. Methods: A consecutive sample of 5711 subjects admitted to the National SCI Database between 1986 ± 1995 was recruited to estimate the incidence of extraspinal fractures associated with acute SCI, strati®ed by anatomic sites, demographics, and injury related characteristics. Results: Of 5711 subjects, 1585 (28%) patients had extraspinal fractures; 580 (37%) patients had more than one fracture site. The most common region of fractures was chest, followed by lower extremity, upper extremity, head, others, and pelvis. The overall incidence rate was higher for women than men, for whites than non-whites, for paraplegics than tetraplegics, and for those injured in motor vehicle crashes than others. Compared with patients having single fracture, those who had multiple fractures were likely to be white, paraplegic, and injured in motor vehicle crashes. There was no age di erence in the incidence of concurrent fractures, single or multiple. Conclusions: Extraspinal fractures are not uncommon at the same time as SCI. The fracture occurrence varies by gender, race, injury level, and etiology of injury. The knowledge of these associated factors will aid in early recognition of fractures, preventing complications, and facilitating rapid mobilization and rehabilitation outcomes among persons with SCI. Spinal Cord (2001) 39, 589 ± 594

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“…4 ± 14 When the 22 fractures treated in the course of this study are classi®ed according to the system of McMaster and Stau er, 11 21 are found to belong in group II (pathologic features caused by lowenergy trauma). In such fractures it has hitherto been standard procedure to apply conservative methods with soft pillows and soft casts.…”

Section: Discussionmentioning

confidence: 96%

“…9 ± 13 In fractures of the lower extremities in chronic paraplegia or tetraplegia, however, conservative treatment is recommended. 5,8,11,14 The complication rate attributed to surgical therapy is too high. Defective alignment of the axis and leg shortening are accepted as unavoidable.…”

Section: Introductionmentioning

confidence: 99%

“…6,8,14 Even conservative treatment is not free of complications, however: complication rates of 19% and 42% have been reported. 11,15 The treatment selected for fractures of the lower extremities in the presence of chronic damage to the spinal cord should achieve secure primary stability and exclude the unnecessary risks inherent in open fracture treatment when the bone is a ected by osteoporosis. Ilizarov's ring ®xation method embodies these advantages.…”

Section: Introductionmentioning

confidence: 99%

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Use of the ring fixator in the treatment of fractures of the lower extremity in long-term paraplegic and tetraplegic patients

et al. 2003

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Study design: Retrospective study. Objectives: To examine the value of operative fracture stabilization by means of the ring ®xator in fractures of the lower extremity in the presence of chronic paralysis caused by transverse lesions of the spinal cord. Setting: A specialist center for the treatment of spinal cord injuries in Germany. Methods: Clinical examination of the lower extremities with side-for-side comparison, radiological investigation of the fractures, patient survey. Patients: In 21 patients with chronic spinal cord lesions, 22 fractures of the lower extremities were treated with the ring ®xator. Results: At follow-up a mean of 41.5 months after fracture healing it could be shown that movement in the knee and ankle joints on the same side as the fracture was not restricted by more than 108 in any of our patients. No losses a ecting activities of daily living were reported, and 19 of the 21 patients were satis®ed with the result achieved with this technique. After four of the 22 operations there were complications. Malalignments were visible radiologically following ®ve of the fractures. Conclusions: In osteoporosis-induced fractures of the lower extremities in chronically paraplegic and tetraplegic patients, fracture stabilization with the ring ®xator, with fewer complications and better results in terms of joint mobility, is superior to the conservative treatment so far given preference in the literature. It should be o ered as an alternative to conservative treatment in the case of pathological fractures.

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The Management of Long Bone Fracture in the Spinal Cord Injured Patient

Cited by 26 publications

References 0 publications

Lower extremity fractures in patients with spinal cord injury

Lower extremity fractures in patients with spinal cord injury

Epidemiology of extraspinal fractures associated with acute spinal cord injury

Use of the ring fixator in the treatment of fractures of the lower extremity in long-term paraplegic and tetraplegic patients

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