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Ung L, Ohlmeier M, Jettkant B, et al. Clinical and Radiological Outcomes After Surgical Treatment of Lower Limb Fractures in Patients With Spinal Cord Injury. Global Spine J. 2019;10(6):715-719doi: 10.1177/2192568219871019.
Ung, L., Ohlmeier, M., Jettkant, B., Grasmücke, D., Aach, M., Meindl, R., Nicolas, V., Schildhauer, T. A., & Citak, M. (2020). Clinical and Radiological Outcomes After Surgical Treatment of Lower Limb Fractures in Patients With Spinal Cord Injury. Global spine journal, 10(6), 715-719. https://doi.org/10.1177/2192568219871019
Ung, Lars, et al. "Clinical and Radiological Outcomes After Surgical Treatment of Lower Limb Fractures in Patients With Spinal Cord Injury." Global spine journal vol. 10,6 (2020): 715-719. doi: https://doi.org/10.1177/2192568219871019
Ung L, Ohlmeier M, Jettkant B, Grasmücke D, Aach M, Meindl R, Nicolas V, Schildhauer TA, Citak M. Clinical and Radiological Outcomes After Surgical Treatment of Lower Limb Fractures in Patients With Spinal Cord Injury. Global Spine J. 2020 Sep;10(6):715-719. doi: 10.1177/2192568219871019. Epub 2019 Aug 19. PMID: 32707017; PMCID: PMC7383793.
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Global Spine J. 2020 Sep;10(6):715-719. doi: 10.1177/2192568219871019. Epub 2019 Aug 19.

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

Global spine journal

Lars Ung, Malte Ohlmeier, Birger Jettkant, Dennis Grasmücke, Mirko Aach, Renate Meindl, Volkmar Nicolas, Thomas A Schildhauer, Mustafa Citak

Affiliations

  1. BG-University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany.

PMID: 32707017 PMCID: PMC7383793 DOI: 10.1177/2192568219871019

Abstract

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 (

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.

Keywords: femur fracture; heterotopic ossification; internal external fixation; open reduction and internal fixation (ORIF); spinal cord injury; tibia fracture

References

  1. Unfallchirurg. 2002 Jul;105(7):612-8 - PubMed
  2. Spinal Cord. 2012 Nov;50(11):803-11 - PubMed
  3. Proc Annu Clin Spinal Cord Inj Conf. 1967 Sep 27;16:77-91 - PubMed
  4. Clin Orthop Relat Res. 1971;77:211-7 - PubMed
  5. Spinal Cord. 2003 Mar;41(3):172-7 - PubMed
  6. Unfallchirurg. 2015 Feb;118(2):130-7 - PubMed
  7. Clin Orthop Relat Res. 1982 Jun;(166):219-25 - PubMed
  8. Clin Orthop Relat Res. 1981 Mar-Apr;(155):65-70 - PubMed
  9. Orthopedics. 2012 Sep;35(9):e1376-82 - PubMed
  10. Clin Orthop Relat Res. 1975 Oct;(112):44-52 - PubMed
  11. J Bone Joint Surg Am. 2008 Sep;90(9):1862-8 - PubMed
  12. Clin Orthop Relat Res. 1988 Aug;(233):86-101 - PubMed
  13. J Trauma. 1991 Oct;31(10):1440-4 - PubMed
  14. Am J Surg. 1950 May;79(5):717-21 - PubMed
  15. J Spinal Cord Med. 2019 Jan;42(1):39-44 - PubMed
  16. J Chronic Dis. 1987;40(5):373-83 - PubMed
  17. Spinal Cord. 2017 Nov;55(11):985-993 - PubMed
  18. Eur Spine J. 2018 Aug;27(8):1798-1814 - PubMed
  19. Jundishapur J Microbiol. 2014 Jan;7(1):e8905 - PubMed
  20. Clin Orthop Relat Res. 1986 Dec;(213):237-40 - PubMed
  21. Spinal Cord. 1997 May;35(5):266-74 - PubMed

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