Sat., 10/20/07 Pediatrics/Spine, Paper #65, 3:53 pm OTA-2007
Operative versus Nonoperative Management of Supracondylar Femur Fracture in
Myelopathic, Nonambulatory Patients
Joseph R. Cass, MD (n); S. Andrew Sems, MD (n);
Mayo Foundation, Rochester, Minnesota, USA
Purpose: Treatment of supracondylar femur fractures in nonambulatory, myelopathic patients has traditionally been nonoperative, with the emphasis on careful skin protection, limited mobilization, and acceptance of malunion. The purpose of this study was to compare the results of surgical treatment with nonsurgical treatment in this patient population.
Methods: A retrospective review of all patients treated for supracondylar femur fractures (OTA code 33) between 2001 and 2006 was performed, and 26 patients with 30 fractures who were nonambulatory due to myelopathy were identified. There were 12 females and 14 males with an average age of 51.8 years (range, 15-93). One patient died in the first month of causes unrelated to the fracture (age 93 years) and the remaining 25 patients with 29 fractures were followed until fracture union or amputation, with an average follow-up of 16 months (range, 3.3-45 months).
Results: Surgical treatment was performed in 17 fractures (13 retrograde intramedullary rods and 4 plates), with nonsurgical treatment in 12 fractures. Union was obtained in all but one of the operatively treated fractures and in 84.5% of nonsurgically treated fractures. One patient treated with a retrograde nail sustained a late intertrochanteric hip fracture treated nonoperatively. There were no other surgical related complications. There was a statistically significant lower skin and wound complication rate in the surgically treated group (P = 0.0407). Skin or wound complications developed in no patients treated surgically and in five patients treated nonsurgically, with three fractures requiring eventual surgery (three above-knee amputations).
Conclusions and Significance: Operative treatment of femoral fractures in nonambulatory patients with myelopathy is a safe and effective method. It avoids the problems of potential skin compromise due to external immobilization, and appears to have lower rates of skin and wound complications than nonsurgically treated supracondylar femur fractures in this patient population.
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