Reduction of bone retropulsed into the spinal canal in thoracolumbar vertebral body compression burst fractures. A prospective randomized comparative study between Harrington rods and two transpedicular devices.

STUDY DESIGN: This was a prospective, randomized study. OBJECTIVE: To compare the ability of three methods of internal fixation (Harrington rods, AO internal fixator, posterior segmental fixator) to obtain reduction of intracanal fragments in thoracolumbar vertebral compression burst fractures. SUMMARY OF BACKGROUND DATA: Sixty-seven acute thoracolumbar compression burst fractures of T12 or L1 were randomized into three groups that were treated using one of the three methods. Reduction was accomplished indirectly by distraction applied using the fixation device. METHODS: The spinal canal encroachment was calculated as a percentage of the estimated pre-injury value from serial transverse computed tomographic scans obtained on admission and immediately after surgery. RESULTS: The median preoperative sagittal encroachment of the spinal canal was 37% (range, 0-90%) of the normal diameter. All three methods of internal fixation produced a spinal canal clearance provided that the patient was operated on within 4 days after trauma. The median postoperative encroachment varied from 13% (range, 0-37%) to 22% (range, 0-37%), the best reduction being attained using Harrington rods and the poorest with the posterior segmental fixator. There was a suggestive statistical significance between these two. CONCLUSION: The differences in postoperative spinal canal encroachment and ability to obtain spinal canal clearance observed between the devices studied were small. There seems to be no reason to base the choice of the operative method in thoracolumbar fractures on any hypothetical differences in reductive power between Harrington rods and the AO internal fixator.

Is the treatment of the most severe multiply injured patients worth the effort? A follow-up examination 5 to 20 years after severe multiple injury.

Ninety-two most severely injured patients--with injuries to at least four body regions with a mean ISS of 39--were examined at the outpatient clinic 5 to 20 years after the trauma. In addition, nine patients were interviewed by phone, thus 92.6% of the patients still alive were contacted. Of those who were not retired before the injury 59 of 82 (72%) had been able to return to work and most of them were still working at the time of the followup. The main reasons for inability to work were brain and spinal cord injuries, blindness, and 'failure in re-education.' Most complaints arose from sequelae of brain, pelvic, and upper and lower extremity injuries. Only seven patients needed constant medication because of their injuries. We conclude that the treatment of even the most severely injured patients with multiple injuries is certainly worth the effort.

Blunt injury patients benefiting from intensive care.

The files of 2,002 trauma patients admitted to our intensive care unit between 1966 and 1984 were analyzed. 74% of the patients were admitted because of the trauma after primary care and 26% later. The main reasons for later admissions were respiratory distress in 11% and postoperative follow-up in 8% of the cases. The series consists of blunt injury patients with a mean age of 39 years for those who survived and 52 years for those who died. 65% of the patients were injured in road traffic accidents. Injuries to the lower extremity were the most frequent (60%) and injuries to the cervical spine the least frequent (11%). The injury Sum (= sum of injuries) ranged from 1 to 18 with an average of 5.6 in the whole series. Two thirds of the patients were multiply injured. A statistical analysis showed that the most important determinants between the dead and those who survived were resuscitation, need for respirator treatment, age of the patient, amount of primary blood transfusions, brain and renal complications. The ICU mortality was 9.0% and the total hospital mortality was 11.9%.

Characteristics of patients with multiple injuries treated in an intensive care unit with favorable results.

A series of 1,169 consecutive patients with multiple injuries was analyzed. A strict criterion for multiple injury was used, the average Injury Sum (sum of the severities of regional injuries) was 7.6, the average time of treatment in the intensive care unit was 11 days and the mean duration of hospital treatment was 51 days. Road traffic accidents were the most common cause of injury (75%) and the regions most commonly injured were the lower extremity (68%), brain (62%) and chest (58%). 46% required ventilation. Mortality was 11.3% during intensive care and the total hospital mortality was 13.1%. The factors most relevant to patients who were able to return home from the hospital were: no need for respirator treatment, no renal complications, no previous mental disturbance or alcoholism, young age, less severe brain or thoracolumbar spine injuries, few initial blood transfusions, few complications during treatment and prompt operative intervention if required.

Unstable fractures of the thoracic and lumbar spine: the audit of an 8-year series with early reduction using Harrington instrumentation.

A series of 112 patients with acute unstable fractures of the thoracic or lumbar spine managed uniformly by early reduction using Harrington's instrumentation was analysed. The level of injury was T6-T11 in 19, T12-L1 in 67 and L2-L5 in 26 patients. On admission, 28 patients had complete paraplegia corresponding to the level of the lesion, 55 had partial lesions and 29 no neural damage. The policy of management comprised reduction by dual distraction rods and simultaneous short posterolateral fusion as an emergency procedure. Anterior decompression of the spinal canal, if required, was performed subsequently. The duration of the postoperative period in bed was 6 weeks. The rods were removed after 9-12 months. The radiographical result and neurological recovery were assessed after an average personal follow-up for 3.1 years. The height of the fractured vertebra was initially well restored, the mean angle of kyphosis being 14 degrees on admission and 5 degrees immediately postoperatively. However, gradually the fractured vertebral body and the intervertebral discs collapsed slightly and at follow-up the mean angle of kyphosis was 12 degrees. On the other hand, the reduction of the initial sagittal displacement of the fractured vertebral body into the spinal canal, could be maintained and a good anatomical end-result was achieved in most cases. The ultimate radiographical results were better after injuries of the thoracic spine and the thoracolumbar junction than after those of the lumbar spine. Improvement of neural function was seen in 28 patients (34 per cent of those with a deficit). Complications of clinical importance occurred in 29 patients.(ABSTRACT TRUNCATED AT 250 WORDS)