Abstract

MANZONE, Patricio et al. Comparative study of orthotic treatment in thoracolumbar fractures according to severity. Rev. Asoc. Argent. Ortop. Traumatol. [online]. 2011, vol.76, n.1, pp.29-40. ISSN 1852-7434.

Background: To determine whether the severity of stable thoraco-lumbosacral trauma is useful to decide on brace type in orthopedic treatment. Methods: Retrospective study (16 years). Inclusion criteria: 1) Minimum follow-up: 2 years. 2) Complete plain radiological studies. 3) No Litigation. 4) TLSO custommade treatment for high kinetic energy trauma and prefabricated orthoses for low energy lesions. 5) Treatment performed or supervised by the senior author. Evaluation by independent observers of Geometric Parameters (sagittal Cobb, vertebral kyphosis, anterior vertebral collapse) initially and at follow-up, and Functional Parameters (SRS pain scale, Oswestry Index, Return to PreviousActivity). Subdivision of different fracture types (AO and Denis classifications) in High (Group A) and Low Energy (Group B) according to the amount of kinetic energy. Comparison with a control group. Statistical analysis: Chi square and Student t-test. 41 patients were studied (44 fractures, 23 females/18 males), 25 fractures were Group A and 19 Group B. Average age: 46 years (12-83). Average follow-up: 4.5 years (2.2-15.5). Predominant site: T11 - L2; predominant types: A (AO), or compression and burst (Denis). Results: There were no significant differences between the initial and follow-up measurements. The only significant difference between groups was found in the initial vertebral kyphosis. However, differences always existed when comparing the geometric parameters between the control group and groups A and B, and between the control group and each type of fracture (AO / Denis) subdivided into high and low energy. The final functional parameters' scores were always good, with significant variations between groups A and B. Conclusions: 1) A satisfactory functional result in stable thoraco-lumbosacral injuries is possible by selecting the type of brace according to the kinetic energy involved. 2) Results appear to be better in High Energy Trauma treated with custom-made orthoses. 3) However, the orthotic treatment according to trauma energy does not change the sagittal radiographic parameters.

Keywords : Thoraco-lumbosacral fractures; High energy; Low energy; Orthosis.

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