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

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).

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.