title: Optimal timing for type C3 thoracic fractures with posterior surgical approach: a retrospective cohort study.
abstract: BACKGROUND
  Type C3 thoracic fracture is a severe spinal injury, but one that is clinically rare, and there are few reports pertaining to the treatment of this type of fracture. No consensus has been achieved on the proper timing of spine fracture fixation; therefore, we focused on evaluating the surgical effects using a posterior approach and determining the influence of surgical timing on surgical outcomes.
  
  
  METHODS
  This was a retrospective cohort study of 36 cases of type C3 thoracic fracture in patients admitted to the hospital from April 2005 to October 2012, and who were divided into two groups according to the timing of surgery: early fixation (<72 h) and late fixation (>72 h). Surgical outcomes were analyzed based on surgery duration, intraoperative blood loss, intensive care unit and hospital stay, mortality rate, and complications.
  
  
  RESULTS
  There were 13 patients in the early fixation group and 23 patients in the late fixation group. Patients were treated with posterior decompression, intervertebral titanium mesh support, pedicle screw fixation, and fusion. All fractures involved a single segment: T7/T8 (8 patients), T9/T10 (11 patients), and T11/T12 (17 patients). All injuries were classified as American Spinal Injury Association (ASIA) grade A. Patients underwent periodic follow-up over a period of 12-30 months (average, 22.5 months). One patient developed ascending myelitis and died of respiratory failure 1 month after early fixation, and two patients died of pulmonary infection after late fixation procedures. Other patients achieved bone fusion without improvement in ASIA grade. No statistically significant difference in parameters was observed between groups.
  
  
  CONCLUSIONS
  Though type C3 thoracic fracture is one of the most severe spinal injuries, complete reduction and recovery of spinal stability can be achieved using a posterior approach. As clinical outcomes in this study were similar between early and late fixation procedures, early surgical intervention may not be helpful for improving neurologic recovery in type C3 thoracic fractures.
authors: Department of Orthopedics, Honghui Hospital of Xi'an Jiaotong University, Youyi east road 555#, Xi'an, Shanxi Province, China.
authors: Haiping
authors: H
authors: Zhang
authors: Qinpeng
authors: Q
authors: Zhao
authors: Baorong
authors: B
authors: He
authors: Jijun
authors: J
authors: Liu
authors: Dingjun
authors: D
authors: Hao
authors: Hua
authors: H
authors: Guo
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000379:methods*; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D065289:Pedicle Screws; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000175:diagnosis / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000293:injuries* / Q000601:surgery; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D055815:Young Adult