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Surgical management of lower limb fractures in patients with spinal cord injury less associated with complications than non-operative management: A retrospective series of cases

The Journal of Spinal Cord Medicine, 2019 · DOI: 10.1080/10790268.2017.1325560 · Published: January 1, 2019

Spinal Cord InjuryMusculoskeletal Medicine

Simple Explanation

Patients with spinal cord injuries often experience bone loss and are prone to fractures, especially in the lower limbs. These fractures can lead to various complications, increasing healthcare costs and impacting patient well-being. The study compares surgical and non-surgical treatments for lower limb fractures in individuals with chronic spinal cord injuries, focusing on the occurrence of overall complications. The findings suggest that surgery may be a preferable option for managing these fractures, as it appears to be associated with fewer overall complications compared to non-surgical methods.

Study Duration
13 years
Participants
40 patients with SCI (24 men and 16 women)
Evidence Level
Retrospective study

Key Findings

  • 1
    The overall rate of complications was significantly higher after non-surgical treatment (63.2%) compared to surgical treatment (25.0%).
  • 2
    Femoral fractures were significantly more likely to be treated with surgery compared to tibial fractures (P < 0.001).
  • 3
    Non-surgical managements were plaster casts (37%) or braces (63%) and surgical treatments were most of the time open reduction with internal fixation such as intramedullary nails (50%).

Research Summary

This retrospective study evaluated the difference in overall complications between surgical and non-surgical management of lower limb fractures in patients with chronic spinal cord injury (SCI). The study found that surgical management was associated with a significantly lower rate of overall complications compared to non-surgical management. The authors conclude that surgery should be systematically considered in patients with SCI and lower-extremity fractures to minimize the risk of complications.

Practical Implications

Treatment protocols

The findings suggest a re-evaluation of treatment protocols for lower limb fractures in SCI patients, with increased consideration of surgical options.

Patient education

Educating patients with SCI about the potential benefits of surgical intervention for fracture management may improve outcomes.

Future research

The study emphasizes the need for a prospective, randomized controlled trial to further compare surgical versus non-operative management.

Study Limitations

  • 1
    The relatively small number of patients constitutes a limitation in our work.
  • 2
    Another limitation could be linked to a selection bias due to the decision making between surgery and conservative treatment, as non-surgical management results from technical difficulties.
  • 3
    The literature analysis clearly shows that medical practice habits are the main factor in decision making.

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