Hospital Course and Complications of Subaxial Cervical Trauma Patients With Tetraplegia or Paraplegia: A Case Series and Literature Review.

STUDY DESIGN: A single-institution, retrospective cohort study. OBJECTIVE: The objective was to present demographic characteristics, mechanism of injuries, lengths of stay, intensive care unit (ICU) days, discharge locations, and causes of 90-day readmission for patients with subaxial spinal cord injuries resulting in paraplegia or tetraplegia. SUMMARY OF BACKGROUND DATA: Spinal cord injuries resulting in paraplegia or tetraplegia are rare injuries with debilitating outcomes. Numerous advances have occurred in caring for these patients, but patients still experience multiple complications. The severity of these injuries and numerous complications result in prolonged hospital stays and the need for extensive rehabilitation. METHODS: Twelve patients with subaxial spinal cord injury resulting in paraplegia or tetraplegia from a level 1 adult trauma center were reviewed. The primary outcomes included hospital length of stay, ICU days, intrahospital complications, 90-day readmission rates, and discharge location. We reviewed the literature for these outcomes in spinal cord injuries. RESULTS: For patients with subaxial spinal cord injuries resulting in paraplegia and tetraplegia, the average age was 36.0 years, and most were male [91.7% (11/12)]. The most common mechanism of injury was gunshot wounds[41.7% (5/12)]. Patients spent an average of 46.3 days in the hospital and 30.7 days in the ICU. Respiratory complications were the most common (9 patients). Fifty percent of patients (6/12) were discharged to the inpatient spinal cord rehab center, and 16.7% (2/12) expired while in the hospital. Two patients (20.0%) were readmitted within 90 days of discharge. CONCLUSIONS: Most patients with subaxial spinal cord injuries resulting in paraplegia or tetraplegia were young males with high-energy traumas. Many patients had intrahospital complications, and most were discharged to the hospital spinal rehab center. These findings likely stem from the severity of paraplegia and tetraplegia injuries and the need for rehabilitation.

Early Surgical Treatment of Thoracolumbar Fractures With Thoracolumbar Injury Classification and Severity Scores Less Than 4.

BACKGROUND: Thoracolumbar fractures (TLFs) are the most common spinal fractures seen in patients with trauma. The Thoracolumbar Injury Classification and Severity (TLICS) classification system is commonly used to help clinicians make more consistent and objective decisions in assessing the indications for surgical intervention in patients with thoracolumbar fractures. Patients with TLICS scores <4 are treated conservatively, but a percentage of them will have failed conservative treatment and require surgery at a later date. METHODS: All patients who received an orthopaedic consult between January 2016 and December 2020 were screened for inclusion and exclusion criteria. For patients meeting the study requirements, deidentified data were collected including demographics, diagnostics workup, and hospital course. Data analysis was conducted comparing length of stay, time between first consult and surgery, and time between surgery and discharge among each group. RESULTS: 1.4% of patients with a TLICS score <4 not treated surgically at initial hospital stay required surgery at a later date. Patients with a TLICS score <4 treated conservatively had a statistically significant shorter hospital stay compared with those treated surgically. However, when time between initial consult and surgery was factored into the total duration of hospital stay for those treated surgically, the duration was statistically equivalent to those treated nonsurgically. CONCLUSION: For patients with a TLICS score <4 with delayed mobilization after 3 days in the hospital or polytraumatic injuries, surgical stabilization at initial presentation can decrease the percentage of patients who fail conservative care and require delayed surgery. Patients treated surgically have a longer length of stay than those treated conservatively, but there is no difference in stay when time between consult and surgery was accounted for. In addition, initial surgery in patients with delayed mobilization can prevent long waits to surgery, while conservative measures are exhausted. LEVEL III EVIDENCE: Retrospective cohort study.

The effect of drill hole size on the fixation strength of a cemented prosthetic patellar button.

This study used a cadaver model to analyze the fixation strength of 3 different patellar resurfacing preparations using an all-polyethylene patellar component. One of 3 drill hole sizes was randomly selected and used to prepare the patella. The entire construct was cemented, mounted to a servohydraulic testing machine, cycled between 0 and 50 N, and then tested to failure. Mean forces obtained prior to failure were 258.5, 293, and 353.1 N for the chamfer, 4.5-mm, and 9.5-mm drill holes, respectively. There was a statistically significant difference in strength to failure between the 9.5-mm and chamfer drill hole sizes. These findings may help to reduce patellar implant failures.

The variability of intramedullary alignment of the femoral component during total knee arthroplasty.

Intramedullary instrumentation for femoral component alignment during total knee arthroplasty is readily used. Newer alignment techniques using computer navigation are now available. This study assesses the difference in the sagittal and coronal plane alignments using a cadaveric model with 3 different entry points for intramedullary alignment compared with a navigation system. Seven cadaveric limb's results show that the anterior starting point resulted in recurvatum (-2.2 degrees +/- 1.4 degrees ), the middle starting point resulted in 1.9 degrees +/- 2.2 degrees of flexion, and the posterior starting point in 3.8 degrees +/- 2.6 degrees of flexion compared with the calculated femoral axis by the computer navigation system. When comparing the valgus angle, no statistical difference between any methods resulted (average 5.2 degrees +/- 0.9 degrees valgus). The anterior and posterior starting points were significantly different in the sagittal plane. These data suggest that alignment can be significantly affected by the starting point chosen for intramedullary instrumentation.