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

Abstract

Objective To review the literature regarding outcomes of surgical and nonsurgical management of lower extremity (LE) fractures in chronic spinal cord injury (SCI). Type Systematic review. Literature Survey Medline (PubMed), Embase, Cochrane Database of Systemic Reviews, Cochrane Central, Cumulative Index to Nursing and Allied Health Literature, http://ClinicalTrials.gov, International Clinical Trials Registry Platform, and International Standard Randomized Controlled Trials were searched from January 1, 1966, to March 1, 2019. Methodology Search was restricted to English language and adults (age ≥ 18 yr). Titles and abstracts were reviewed for relevance to study topics for inclusion. Case reports, reviews, non‐SCI population studies, and studies examining fractures at the time of acute SCI were excluded. References of included articles from the original search and task force and external submissions yielded two additional articles that were included in the review after voting by task force members. Data extraction was performed by four task force members using a data extraction form, glossary, and instructions created in Microsoft Excel. Quality assessment was performed by three methodologists using prespecified criteria. Synthesis Twenty‐three articles were included. Use of surgery to treat LE fractures in chronic SCI has increased, though nonoperative management was still more frequently reported. Regardless of type of management, amputations, nonunion/malunion, and pressure injuries were among the most commonly reported complications. Functional and quality of life outcomes were less frequently reported. Conclusions There is insufficient evidence to support operative versus nonoperative management as best practice for management of LE fracture of SCI. Existing literature was limited by small sample sizes, lack of randomization or matched study designs, significant heterogeneity in populations and treatment strategies studied, and variability in defining and reporting outcomes of interest. The field would benefit from future research to address study design issues and standardization of outcome reporting to facilitate comparison of outcomes of operative versus nonoperative management.

Acute Lower Extremity Fracture Management in Chronic Spinal Cord Injury

“…These questions formed the basis of a literature search, the findings of which were published as a systematic review 20 . A multidisciplinary expert panel consisting of orthopaedic surgeons, physiatrists, physical therapists, health service and clinical researchers, an endocrinologist, a rheumatologist, and a hematologist was convened.…”

“…The guidelines were informed in part by the AAOS Clinical Practice Guidelines and Systematic Review methodology 21 . Information from the systematic review 20 , semi-structured interviews of physical and occupational therapists 22 , additional manual searches of the literature performed by members of the expert panel to inform particular areas of knowledge gaps, and expert opinion by members of the task force formed the basis for the recommendations. Panel members consulted with content experts when needed.…”

The improvement of the lower limb exoskeletons on the gait of patients with spinal cord injury

“…The incidence of non-traumatic spinal cord injury in developed countries is higher than that of traumatic spinal cord injury, with a rate of 9.3 per million inhabitants per year. In the process of SCI rehabilitation treatment, improving patients’ walking ability, self-care ability and self-esteem is an important aspect of their return to society, [3] which can also reduce the cost of patients, among other rehabilitation targets, regaining independent ambulation has been demonstrated to be a high priority for recovery among patients with SCI [4] . So the rehabilitation of lower limbs is very important [5] .…”