Functional and radiographic outcome of thoracolumbar and lumbar burst fractures managed by closed orthopaedic reduction and casting.
METHODS
Retrospective review.


OBJECTIVE
To determine clinical and radiographic outcomes of thoracolumbar and lumbar burst fractures without neurologic injury treated by closed reduction and casting. Patient factors associated with poor outcome are identified.


BACKGROUND
The results of ambulatory bracing, surgery, and prolonged recumbency for burst fractures have been reported. There are no reports of results of closed reduction and casting.


METHODS
Retrospective review of 41 neurologically intact patients with thoracolumbar and lumbar burst fractures was performed. Four patients with neurologic injury who refused surgery were included, for a total of 45 patients. All patients had closed reduction and casting. Functional, pain, and employment status were assessed using the Denis system. Neurologic function was graded using the Frankel scale. Radiographic evaluation of vertebral kyphosis, regional kyphosis, anterior body compression, and sagittal index were performed at time of injury, postreduction, 4 months, and final follow-up.


RESULTS
Sixty-four percent of patients had minimal or no pain. Eight percent had constant, severe pain. At time of injury, 71% of patients were employed. At 8-month follow-up, 58% of patients were employed. Closed reduction resulted in significant correction of vertebral wedging from a mean of 15 degrees to 5 degrees. Deformity tended to recur by 4 months, but the degree of residual deformity appears to be less than that reported in other series. No complications resulted from the fracture reduction procedure.


CONCLUSIONS
Closed reduction and casting of thoracolumbar and lumbar burst fractures is a safe treatment method that yields acceptable functional and radiographic results.
Department of Orthopaedic Surgery, CHU Hôpital Nord, Marseille, France. ptropiano@ap-hm.fr
Patrick
P
Tropiano
Russel C
RC
Huang
Christian A
CA
Louis
Dominique G
DG
Poitout
Rene P
RP
Louis
D000041:Absenteeism; D000293:Adolescent; D000328:Adult; D000368:Aged; D002370:Casts, Surgical; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D010146:Pain / Q000453:epidemiology; D011859:Radiography; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000628:therapy*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D014143:Traction / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome