[Surgery for Fractures of the Lower Extremities in Cases of Chronic Spinal Cord Injury]

Overview

Journal Orthopade

Specialty Orthopedics

Date 2005 Jan 15

PMID 15650821

Citations 6

Authors

C Barlehner

V Bohm

R Flieger

T Meiners

Affiliations

Soon will be listed here.

Abstract

According to the literature, the need for surgical treatment of fractures of the lower extremity in patients with chronic spinal cord injury (SCI) is very limited. Conservative management is usually presented as the treatment of choice. We present the results of a retrospective review of 55 fractures in 44 patients from 1996 to 2000 which were managed surgically. Rating of the outcome was based on basic clinical and radiological criteria. The results of the radiological investigation on bone remodeling and bone positioning after healing were rated as good or excellent in 43 and fair in five limbs. In five cases, the treatment failed. For 53 of the 55 fractures, the patients regained their normal level of independence. Comparing our results to those presented in the literature, we clearly had fewer complications as well as better clinical and radiological results. We therefore advocate surgical treatment as an appropriate choice of treatment for lower extremity fractures of patients with chronic SCI.

Citing Articles

The Pathophysiology, Identification and Management of Fracture Risk, Sublesional Osteoporosis and Fracture among Adults with Spinal Cord Injury.

Craven B, Cirnigliaro C, Carbone L, Tsang P, Morse L J Pers Med. 2023; 13(6).

PMID: 37373955 PMC: 10300795. DOI: 10.3390/jpm13060966.

Lower extremity fracture prevention and management in persons with spinal cord injuries and disorders: The patient perspective.

Etingen B, Carbone L, Guihan M, Ray C, Aslam H, Elam R J Spinal Cord Med. 2021; 45(6):946-956.

PMID: 33830880 PMC: 9662005. DOI: 10.1080/10790268.2021.1907675.

Lower extremity fractures in patients with spinal cord injury characteristics, outcome and risk factors for non-unions.

Grassner L, Klein B, Maier D, Buhren V, Vogel M J Spinal Cord Med. 2017; 41(6):676-683.

PMID: 28545316 PMC: 6217470. DOI: 10.1080/10790268.2017.1329915.

Long-bone fractures in persons with spinal cord injury.

Frotzler A, Cheikh-Sarraf B, Pourtehrani M, Krebs J, Lippuner K Spinal Cord. 2015; 53(9):701-4.

PMID: 25987003 DOI: 10.1038/sc.2015.74.

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

Bethel M, Bailey L, Weaver F, Le B, Burns S, Svircev J Spinal Cord. 2015; 53(5):402-7.

PMID: 25622728 DOI: 10.1038/sc.2015.5.

References

COMARR A, Hutchinson R, BORS E . Extremity fractures of patients with spinal cord injuries. Am J Surg. 1962; 103:732-9. DOI: 10.1016/0002-9610(62)90256-8. View

STAUB P . Orthopedic surgery on paraplegic patients. Am J Surg. 1950; 79(5):717-21. DOI: 10.1016/0002-9610(50)90339-4. View

Biering-Sorensen F, BOHR H, Schaadt O . Longitudinal study of bone mineral content in the lumbar spine, the forearm and the lower extremities after spinal cord injury. Eur J Clin Invest. 1990; 20(3):330-5. DOI: 10.1111/j.1365-2362.1990.tb01865.x. View

Sobel M, Lyden J . Long bone fracture in a spinal-cord-injured patient: complication of treatment--a case report and review of the literature. J Trauma. 1991; 31(10):1440-4. View

Levine A, Krebs M . External fixation in quadriplegia. Clin Orthop Relat Res. 1984; (184):169-72. View

Mize R, Bucholz R, Grogan D . Surgical treatment of displaced, comminuted fractures of the distal end of the femur. J Bone Joint Surg Am. 1982; 64(6):871-9. View

Schmeiser G, Vastmans J, Potulski M, Hofmann G, Buhren V . [Retrograde intramedullary nailing of knee para-articular fractures in paraplegic patients]. Unfallchirurg. 2002; 105(7):612-8. DOI: 10.1007/s00113-001-0400-5. View

Ingram R, Suman R, Freeman P . Lower limb fractures in the chronic spinal cord injured patient. Paraplegia. 1989; 27(2):133-9. DOI: 10.1038/sc.1989.20. View

CHANTRAINE A, Nusgens B, Lapiere C . Bone remodeling during the development of osteoporosis in paraplegia. Calcif Tissue Int. 1986; 38(6):323-7. DOI: 10.1007/BF02555744. View

10.

Szollar S, Martin E, Sartoris D, Parthemore J, Deftos L . Bone mineral density and indexes of bone metabolism in spinal cord injury. Am J Phys Med Rehabil. 1998; 77(1):28-35. DOI: 10.1097/00002060-199801000-00005. View

11.

Leslie W, Nance P . Dissociated hip and spine demineralization: a specific finding in spinal cord injury. Arch Phys Med Rehabil. 1993; 74(9):960-4. View

12.

Abramson A . Bone disturbances in injuries to the spinal cord and cauda equina (paraplegia) their prevention by ambulation. J Bone Joint Surg Am. 1948; 30A(4):982-7. View

13.

McMaster W, Stauffer E . The management of long bone fracture in the spinal cord injured patient. Clin Orthop Relat Res. 1975; (112):44-52. View

14.

Meiners T, Keil M, Flieger R, Abel R . Use of the ring fixator in the treatment of fractures of the lower extremity in long-term paraplegic and tetraplegic patients. Spinal Cord. 2003; 41(3):172-7. DOI: 10.1038/sj.sc.3101397. View

15.

Tricot D, Hallot R . Traumatic paraplegia and associated fractures. Paraplegia. 1968; 5(4):211-5. DOI: 10.1038/sc.1967.33. View

16.

Cochran T, Bayley J, Smith M . Lower extremity fractures in paraplegics: pattern, treatment, and functional results. J Spinal Disord. 1988; 1(3):219-23. View

17.

Freehafer A, MAST W . LOWER EXTREMITY FRACTURES IN PATIENTS WITH SPINAL-CORD INJURY. J Bone Joint Surg Am. 1965; 47:683-94. View

18.

Wilmet E, Ismail A, Heilporn A, Welraeds D, Bergmann P . Longitudinal study of the bone mineral content and of soft tissue composition after spinal cord section. Paraplegia. 1995; 33(11):674-7. DOI: 10.1038/sc.1995.141. View

19.

Aho A, Hakkarainen S . Closed leg fractures. Conservative or operative treatment in the light of complications of 510 fractures during 1957-1968. Acta Chir Scand. 1974; 140(6):457-65. View

20.

Freehafer A . Limb fractures in patients with spinal cord injury. Arch Phys Med Rehabil. 1995; 76(9):823-7. DOI: 10.1016/s0003-9993(95)80546-x. View