A review of long-bone fractures in patients with spinal cord injuries.

In a retrospective investigation of 38 long-bone fractures in 30 spinal cord injured patients (mean follow-up, 22 months), fractures were classified acute (occurring at the time of spinal cord injury) or pathologic (occurring in the chronically injured patient). The methods of treatment and complications were recorded and evaluated. The incidence of long-bone fractures was 6.7%. Complication rates were high, ranging from 20% to 40%, with open or closed treatment of extremity fractures. Strict adherence to established operative fracture management principles in paraplegic patients irrespective of the level of neurologic deficit. Extremity fractures treated by nonoperative splinting and skin care healed well even in patients with long-standing paraplegia. Hip fractures were usually openly reduced internally fixed to improve sitting balance. The question of absolute benefit from early long-bone stabilization in the spinal cord injured patient remains unanswered.