Treatment of Lower-extremity Long-bone Fractures in Active, Nonambulatory, Wheelchair-bound Patients

Sugi, Michelle T.; Davidovitch, Roy I.; Montero, Nicole; Nobel, Tamar; Egol, Kenneth A

doi:10.3928/01477447-20120822-25

Cited by 17 publications

(25 citation statements)

References 21 publications

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“…The rationale for the operative management of long bones in paralysed limbs is based on the early return to previous activities and high patient satisfaction. 2,13 However, strong recommendations concerning operative or conservative treatment of long-bone fractures in SCI individuals cannot be drawn from our data, due to the retrospective study design. For this purpose, prospective controlled interventional studies would be required.…”

Section: Discussionmentioning

confidence: 82%

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Long-bone fractures in persons with spinal cord injury

et al. 2015

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Study design: Retrospective data analysis. Objectives: To document fracture characteristics, management and related complications in individuals with traumatic spinal cord injury (SCI). Setting: Rehabilitation centre for SCI individuals. Method: Patients' records were reviewed. Patients with traumatic SCI and extremity fractures that had occurred after SCI were included. Patient characteristics, fractured bone, fracture localisation, severity and management (operative/conservative), and fracturerelated complications were extracted. Results: A total of 156 long-bone fractures in 107 SCI patients (34 women and 73 men) were identified. The majority of patients were paraplegics (77.6%) and classified as American Spinal Injury Association Impairment Scale A (86.0%). Only the lower extremities were affected, whereby the femur (60.9% of all fractures) was fractured more frequently than the lower leg (39.1%). A total of 70 patients (65.4%) had one fracture, whereas 37 patients (34.6%) had two or more fractures. Simple or extraarticular fractures were most common (75.0%). Overall, 130 (83.3%) fractures were managed operatively. Approximately half of the femur fractures (48.2%) were treated with locking compression plates. In the lower leg, fractures were mainly managed with external fixation (48.8%). Conservative fracture management was applied in 16.7% of the cases and consisted of braces or a well-padded soft cast. Fracture-associated complications were present in 13.5% of the cases but did not differ significantly between operative (13.1%) and conservative (15.4%) fracture management. Conclusion: SCI was associated with simple or extraarticular fractures of the distal femur and the lower leg. Fractures were mainly managed operatively with a low complication rate.

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Section: Discussionmentioning

confidence: 82%

“…12 However more recently, operative fracture management has been advocated. 2,13 Generally, the goal of fracture management is the restoration of the level of prefracture activity and functioning of the patient. 2,4 As a consequence, an individual approach to fracture treatment has been recommended.…”

Section: Introductionmentioning

confidence: 99%

Long-bone fractures in persons with spinal cord injury

et al. 2015

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“…In support of this, others have reported that nonsurgical treatment of fractures may be associated with complications 7,[27][28][29] and have observed good outcomes with primary surgical treatments. 32 In addition, several studies have suggested that surgical treatment of fractures in SCI patients may expedite post-fracture mobilization. 26,32 Conversely, other reports 9,28,33,34 have found nonsurgical treatments to be effective.…”

Section: Discussionmentioning

confidence: 99%

“…32 In addition, several studies have suggested that surgical treatment of fractures in SCI patients may expedite post-fracture mobilization. 26,32 Conversely, other reports 9,28,33,34 have found nonsurgical treatments to be effective.…”

Section: Discussionmentioning

confidence: 99%

Surgical compared with nonsurgical management of fractures in male veterans with chronic spinal cord injury

et al. 2015

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Study design: Retrospective review of a clinical database. Objectives: To examine treatment modalities of incident appendicular fractures in men with chronic SCI and mortality outcomes by treatment modality. Setting: United States Veterans Health Administration Healthcare System. Methods: This was an observational study of 1979 incident fractures that occurred over 6 years among 12 162 male veterans with traumatic SCI of at least 2 years duration from the Veterans Health Administration (VA) Spinal Cord Dysfunction Registry. Treatment modalities were classified as surgical or nonsurgical treatment. Mortality outcomes at 1 year following the incident fracture were determined by treatment modality. Results: A total of 1281 male veterans with 1979 incident fractures met inclusion criteria for the study. These fractures included 345 (17.4%) upper-extremity fractures and 1634 (82.6%) lower-extremity fractures. A minority of patients (9.4%) were treated with surgery. Amputations and disarticulations accounted for 19.7% of all surgeries (1.3% of all fractures), and the majority of these were done more than 6 weeks following the incident fracture. There were no significant differences in mortality among men with fractures treated surgically compared with those treated nonsurgically. Conclusions: Currently, the majority of appendicular fractures in male patients with chronic SCI are managed nonsurgically within the VA health-care system. There is no difference in mortality by type of treatment.

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“…In 2012, Sugi et al 19 successfully treated 11 cases either by ORIF or by intramedullary nailing. The interesting fact of that study is that patients reached the initial life quality measured by the performed questionnaires.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Radiological Outcomes After Surgical Treatment of Lower Limb Fractures in Patients With Spinal Cord Injury

Ung

Ohlmeier

Jettkant

et al. 2019

Global Spine Journal

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Study Design: Retrospective observational study. Objectives: To analyze the clinical and radiological outcomes of lower limb fractures following surgical treatment in patients with chronic spinal cord injury (SCI). Methods: Between January 2003 and December 2015, 102 chronic SCI patients with a lower limb fracture were surgically treated at our hospital. A total of 58 patients met the inclusion criteria and were recruited for final analysis. Patients with 2-stage procedure or incomplete clinical records with lost-to-follow-up were excluded from the study. Patients were divided into 2 groups (group 1= internal fixation; group 2 = external fixation). Primary outcome measures were to identify the number of nonunions via Kaplan-Meier analysis and the time to bone consolidation. The diagnosis of a pseudarthrosis was made after more than 180 days of consolidation time. Considering the Kaplan-Meier analysis, pseudarthrosis was interpreted as treatment failure. Secondary outcome measure was to evaluate the complication rate with special focus on heterotopic ossification. Results: A total of 58 chronic SCI patients with closed bone fractures were included in this study. Fifty-two fractures (88%) were simple and 7 (12%) were complex (type C) fractures according to AO classification. The majority of patients (34 cases, 59%) developed femur fractures followed by 24 tibial fractures (41%). Seventeen patients received an external (29%) and 41 an internal fixation (71%). Bone consolidation was reported in 31 patients (53%) with a mean time interval of bone consolidation after 97 days (range from 45 to 160 days; SD = 30). The reported nonunion (pseudarthrosis) rate was 47%. Comparing the internal group (n = 15 patients) versus the external group (n = 14), we could not find any significant difference ( P = .939) concerning the bone consolidation time. The Kaplan-Meier analysis showed a 75% cumulative survivorship at 120 days (internal group) versus 111 days (external group). Most common postoperative complications occurred in the internal fixation group with Wound infections being predominantly observed (10%), followed by heterotopic ossifications (8%). Conclusions: Our results show that surgical treatment of lower limb fractures in chronic SCI patients is a challenging treatment with a high pseudarthrosis rate in both groups. The complication rate seems to be lower in the patients treated with external fixation. As a clinical recommendation, longer implants should be used for a stable osteosynthesis since SCI patients seem to have a higher load on the osteosynthesis material due to missing sensomotoric feedback.

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Treatment of Lower-extremity Long-bone Fractures in Active, Nonambulatory, Wheelchair-bound Patients

Cited by 17 publications

References 21 publications

Long-bone fractures in persons with spinal cord injury

Long-bone fractures in persons with spinal cord injury

Surgical compared with nonsurgical management of fractures in male veterans with chronic spinal cord injury

Clinical and Radiological Outcomes After Surgical Treatment of Lower Limb Fractures in Patients With Spinal Cord Injury

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