Sequential distraction and reduction for upper-middle thoracic fracture with severe overlapping dislocation

English Keywords:Thoracic vertebra  Fracture  Dislocation

English Abstract:

  【Abstract】 Objective：To investigate the feasibility and clinical outcome of sequential distraction and reduction for upper-middle thoracic fracture with severe overlapping dislocation.Method：12 patients suffering severe fresh upper-middle thoracic fracture complicated with overlapping dislocation from March 2006 to March 2008 were reviewed retrospectively.According to AO classification，there were 2 B1 type，1 B2 type，3 C1 type and 6 C 3 type.As for overlapping distance，there were less than 1 vertebra in 3 cases，between 1 and 2 vertebrae in 7 cases and over 2 vertebrae in 2 cases.The preoperative Frankel scale was A class in 11 cases，C class in 1 case.After complete decompression，sequential distraction and reduction，and autograft bone fusion via posterior pedicle instrumentation were conducted in all cases.The clinical outcome was followed up.Result：As for complications，there were 1 mild back pain，1 bilateral hips osteoarthritis，1 pressure sore and 2 urinary infection，all healed well after conservative treatment.Postoperative radiograph showed complete recovery of thoracic length and alignment in 11 of 12 cases，except 1 case having Ⅰ degree transplacement.All patients resumed partial self-dependence activity by wheel-chair about 7 days after operation.The mean thoracic kyphosic angle restored to 33°（range，15°-39°） with no obvious correction loss or instrument failure after 18 months（6-24 months） follow-up，and the bony fusion was evidenced in all cases.The final Frankel scale was Frankel A in 10 cases，Frankel B in 1 case，and Frankel D in 1 case.Conclusion：For acute upper-middle thoracic fracture complicated with severe overlapping dislocation，early sequential distraction and reduction by pedicle screws is feasible and effective.