title: Lower extremity fractures in paraplegics: pattern, treatment, and functional results.
abstract: Eighty-seven lower extremity fractures in 71 paraplegics were retrospectively evaluated to determine adequacy of treatment, functional result, and range of motion of the hip and knee. Most fractures treated closed healed without difficulty, but with a complication rate of 19%. Length of hospitalization averaged almost 3 months in the group treated closed, and residual hip and knee stiffness was the major complication. This was not a problem except in high demand patients, such as wheelchair athletes, in whom decreased range of motion was a significant limitation. Treatment with circular casts produced a high number of complications and is not recommended for patients with insensate skin. Open reduction and internal fixation is recommended for a small subgroup of paraplegics: wheelchair athletes, hip fractures, and those in whom autonomic dysreflexia and/or uncontrollable spasticity due to fracture manipulation is a significant hazard.
authors.affiliation: Section of Orthopaedic Surgery, West Roxbury VA Medical Center, Harvard Medical School, Massachusetts.
authors.forename: T P
authors.initials: TP
authors.lastname: Cochran
authors.forename: J C
authors.initials: JC
authors.lastname: Bayley
authors.forename: M
authors.initials: M
authors.lastname: Smith
mesh_terms: D001858:Bone Nails; D001860:Bone Plates; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone / Q000209:etiology* / Q000601:surgery / Q000628:therapy; D006801:Humans; D007869:Leg Injuries / Q000209:etiology* / Q000601:surgery / Q000628:therapy; D009989:Orthotic Devices; D010264:Paraplegia / Q000150:complications* / Q000503:physiopathology; D011183:Postoperative Complications; D012189:Retrospective Studies