Pathologic Extremity Fracture Care in Spinal Cord Injury

Abstract

Fracture management in chronic SCI can be summarized by the following principles. Fractures in the upper extremity and in incomplete SCI are treated by standard orthopedic guidelines. Nondisplaced femoral neck fractures require cannulated screw fixation, whereas displaced fractures require an endoprosthesis. Nondisplaced intertrochanteric and subtrochanteric hip fractures may be treated nonoperatively in the elderly or medically ill, but those who require mobilization and a predictable outcome require intramedullary hip screw (IMHS) fixation. Femoral shaft and displaced tibia shaft fractures require intramedullary locked nails. Most periarticular knee fractures may be managed by nonoperative splinting. Nondisplaced fractures of the tibia and below are treated by nonoperative means.