Patterns and short term outcomes of thoracolumbar fractures at Moi Teaching and Referral Hospital, Eldoret Kenya

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