Management of Femoral and Tibial Shaft Fractures in Patients With Chronic Spinal Cord Injury.

IF 1.6 3区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Trauma Pub Date : 2024-11-01 DOI:10.1097/BOT.0000000000002902

Andres Fidel Moreno-Diaz, Cade A Morris, Sarah Obudzinski, Patrick R Taylor, Marissa Pazik, Jaquelyn Kakalecik, Michael Talerico, Laura Lins, Gabrielle Kuhn, Paul Whiting, Andrew Chen, Andrew Farley Tyler, Phillip M Mitchell, William T Obremskey

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引用次数: 0

Abstract

Objectives: To compare outcomes and complications between nonoperative and operative management of femur and tibia fractures in patients with paraplegia or quadriplegia from chronic spinal cord injury (SCI).

Methods:

Design: Retrospective cohort study.

Setting: Three Level-1 Trauma centers.

Patient selection criteria: All adult patients with paraplegia or quadriplegia due to a chronic SCI with operative or nonoperative treatment of a femoral or tibial shaft fracture from January 1, 2009 through December 31, 2019 were included.

Outcome measures and comparisons: Outcomes collected included range of motion, pain, return to baseline activity, extent of malunion, and treatment complications (infection, pressure ulcers, nonunion, deep vein thrombosis/pulmonary emobolus, stroke, amputation, death). Comparison between operative and nonoperative treatment were made for each outcome.

Results: Fifty-nine patients with acute lower extremity fracture in the setting of chronic SCI fulfilled inclusion criteria with a median age of 46 years in the operative group and 47 years in the nonoperative group. Twelve patients (70.6%) in the nonoperative group were male with 32 (76.2%) male patients in the operative group. Forty-six patients (78%) presented as low energy trauma. Differences were seen between operative and nonoperative management for pressure ulcers (19% vs. 52.9%, P = 0.009) and mean Visual Analog Scale pain score at first follow-up (1.19 vs. 3.3, P = 0.03). No difference was seen for rates of infection, nonunion, deep vein thrombosis/pulmonary emobolus, stroke, amputation, death, return to baseline activity, and range of motion.

Conclusions: Tibial and femoral shaft fractures commonly resulted from low energy mechanisms in patients with chronic SCI. Operative treatment seemed to decrease morbidity in these patients via lowered rates of pressure ulcers and decreased pain compared with nonoperative management.

Level of evidence: Therapeutic, Level III. See Instructions for Authors for a complete description of levels of evidence.

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慢性脊髓损伤患者股骨和胫骨轴骨折的处理。

目的比较慢性脊髓损伤（SCI）截瘫或四肢瘫痪患者股骨和胫骨骨折非手术治疗与手术治疗的疗效和并发症：设计：回顾性队列研究：设计：回顾性队列研究：三家一级创伤中心：所有在2009年1月1日至2019年12月31日期间接受股骨或胫骨轴骨折手术或非手术治疗的因慢性SCI导致截瘫或四肢瘫痪的成年患者均纳入研究范围：收集的结果包括活动范围、疼痛、基线活动恢复情况、骨折不愈合程度和治疗并发症（感染、压疮、骨折不愈合、深静脉血栓/PE、中风、截肢、死亡）。对每种结果都进行了手术治疗和非手术治疗的比较：59例慢性SCI急性下肢骨折患者符合纳入标准，手术组患者的中位年龄为46岁，非手术组患者的中位年龄为47岁。非手术组中有 12 名男性患者（占 70.6%），手术组中有 32 名男性患者（占 76.2%）。46名患者（78%）为低能量创伤。在压疮（19% vs 52.9%，P=0.009）和首次随访时平均 VAS 疼痛评分（1.19 vs 3.3，P=0.03）方面，手术和非手术治疗存在差异。在感染率、未愈合率、深静脉血栓/PE、中风、截肢、死亡、恢复基线活动和活动范围等方面没有差异：结论：慢性 SCI 患者的胫骨和股骨干骨折常见于低能量机制。与非手术治疗相比，通过降低压疮发生率和减轻疼痛，手术治疗似乎可以降低这些患者的发病率：预后III级。有关证据等级的完整描述，请参阅 "作者须知"。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Orthopaedic Trauma 医学-运动科学

CiteScore

3.90

自引率

8.70%

发文量

396

审稿时长

3-8 weeks

期刊介绍： Journal of Orthopaedic Trauma is devoted exclusively to the diagnosis and management of hard and soft tissue trauma, including injuries to bone, muscle, ligament, and tendons, as well as spinal cord injuries. Under the guidance of a distinguished international board of editors, the journal provides the most current information on diagnostic techniques, new and improved surgical instruments and procedures, surgical implants and prosthetic devices, bioplastics and biometals; and physical therapy and rehabilitation.