Perkins Crystal, Buck Joseph Stewart, Karunakar Madhav A
Bull Hosp Jt Dis (2013). 2019 Sep;77(3):211-215.
Spinal cord injured patients have an estimated 25% to 34% lifetime incidence of sustaining an extremity fracture. The objective of this study is to describe the outcomes of femur fractures treated in patients with pre-existing spinal cord injury (SCI) and lower extremity paraplegia.
An IRB approved retrospective review of patients 18 years of age and older who sustained a femur fracture a minimum of 2 years following spinal cord injury and received treatment at a regional academic level 1 trauma center over a 10-year period was performed. Patients were divided into two groups based on whether they received operative or nonoperative management of the femoral shaft fracture. The primary outcome assessed was re-operation. Additional outcomes including union, infection, implant failure, and mortality were recorded.
Twenty-one patients sustaining a total of 25 femur fractures were identified. The most common mechanism of injury was fall during transfer. Sixteen fractures were treated non-operatively and nine were treated operatively. At a mean of 4.1 years of follow-up (range: 1.1 to 12.1 years) six out of nine (66.7%) patients in the operative group required an unplanned secondary surgery compared to two patients (12.5%) in the non-operative group (p = 0.006). Overall, the rate of fracture union was 48%, and there was no difference seen between treatment groups (56.3% in nonoperative group versus 33.3% in operative group, p = 0.28). Six operative patients (66.7%) developed an infection as compared to one patient (6.3%) in the non-operative group (p = 0.002). Three operative patients (33.3%) had failure of fixation with implant cutout. One patient died within 2 years of fracture in the non-operative group (6.3%) as did one patient in the operative group (11.1%), (p = 1.0).
Surgical treatment of femur fractures in patients with a pre-existing SCI and lower extremity paraplegia had a higher rate of complications than nonoperative management in our series. Based on our experience, we recommend non-operative treatment of femur fractures in patients with pre-existing spinal cord injury and lower extremity paraplegia.
据估计，脊髓损伤患者一生中发生四肢骨折的发生率为25%至34%。本研究的目的是描述在已有脊髓损伤（SCI）和下肢截瘫的患者中治疗股骨骨折的结果。
对18岁及以上在脊髓损伤至少2年后发生股骨骨折并在地区一级学术创伤中心接受治疗达10年的患者进行了一项经机构审查委员会批准的回顾性研究。根据患者是否接受股骨干骨折的手术或非手术治疗，将其分为两组。评估的主要结果是再次手术。记录了包括骨折愈合、感染、植入物失败和死亡率在内的其他结果。
共确定了21例发生25处股骨骨折的患者。最常见的受伤机制是转移过程中摔倒。16处骨折接受了非手术治疗，9处接受了手术治疗。平均随访4.1年（范围：1.1至12.1年），手术组9例患者中有6例（66.7%）需要进行计划外二次手术，而非手术组为2例患者（12.5%）（p = 0.006）。总体而言，骨折愈合率为48%，治疗组之间未见差异（非手术组为56.3%，手术组为33.3%，p = 0.28）。6例手术患者（66.7%）发生感染，而非手术组为l例患者（6.3%）（p = 0.002）。3例手术患者（33.3%）出现植入物切出导致的内固定失败。非手术组1例患者（6,3%）在骨折后2年内死亡，手术组也有1例患者（11.1%）死亡，（p = 1.0）。
在我们的系列研究中，已有SCI和下肢截瘫患者的股骨骨折手术治疗并发症发生率高于非手术治疗。根据我们 的经验，我们建议对已有脊髓损伤和下肢截瘫的患者的股骨骨折进行非手术治疗。
