Abstract:
Background: Spine fractures are high energy injuries arising from various forms
of trauma and assuming differing morphology. Ninety percent of all spinal fractures
occur in the thoracolumbar region. These are associated with high morbidity due to a
15% risk of spinal cord injury. In 2013 a total of 28 patients were seen with
thoracolumbar fractures at MTRH. There is no published information on the outcomes
of these injuries. This study sought bridge this gap.
Objective: To determine the etiology, morphology and short term outcomes of
thoracolumbar fractures in patients seeking treatment at MTRH.
Methods: This was a descriptive prospective study involving patients with
thoracolumbar fractures carried out at MTRH orthopedics wards and outpatient fracture
clinic. Approval to conduct the study was obtained from IREC (FAN 1276) and MTRH
administration. The study population included patients presenting with thoracolumbar
fractures at MTRH. Consecutive sampling was used. Informed consent was obtained
before enrollment. Data collection was via interviewer administered questionnaire,
summary of file notes and patients x-ray interpretation. At 12 weeks the patients ASIA
(American Spinal Injury Association Impairment) scale was reassessed and compared
with the score at initial contact. Data was entered into MS Excel and analysis done
using standard software for statistical analysis and computation and presented in prose,
tables and graphs.
Results: A total of 40 patients were enrolled in this study with a mean age of
36.1(±13.2). The youngest patient was 18 years and the eldest 70 years. Males were
more affected with a M:F ratio of 3.7:1. More than half of the fractures (52.5%) were
due to falls from a height, 35.5% from road traffic accidents and 7.5% were as a result
of assault. Morphologically 48% of the fractures were Magerl type A, 39% type B and
15% were type C. Less than half of patients (44%) had associated injuries with long
bone fractures being the most common at 40%. Operative treatment was done in 40%
of the patients while the rest were treated non-operatively. At the point of recruitment
59% of the patients were at ASIA E, 17% at ASIA D, 8% at ASIA C, 3% at ASIA B
and 13% were at ASIA A. After 12 weeks of follow up there was no significant change
in the ASIA category. One mortality (ASIA A) occurred during the course of the study
due to severe chest injury.
Conclusion: Majority of the patients were young males, casual labourers with
thoracolumbar fractures due to falls from a height. Magerl type A fractures were the
commonest finding. Long bone fractures were the most common associated injury.
Treatment was mainly conservative. There was little or no change in ASIA score after 3
months of follow up.
Recommendation: There is need for public education on the use of personal
protective equipment especially in individuals working from heights. Health workers
need to be on the lookout for other injuries in patients with thoracolumbar fractures as
they may increase the morbidity and mortality of these fractures