Traumatic spinal cord injury with associated long-bone fractures, timing of spinal stabilization vs. fixation and effect on outcomes
DOI:
https://doi.org/10.65759/j0xjea04Keywords:
Spinal cord injuries, spinal fractures, long-bone fractures, fracture fixation, surgical decompressionAbstract
Background: Traumatic spinal cord injury with associated long-bone fractures is a surgical priority. Spinal decompression targets neurological recovery, and fracture fixation target skeletal stability and rehabilitation. This review examined timing, operative sequencing, and clinical outcomes. Methods: Literature published from inception to 31 May 2026 was searched. We include ten original studies organized into data involving concurrent spinal cord injury and limb fractures or indirect evidence concerning spinal surgery and polytrauma fracture fixation. Heterogeneity supported narrative synthesis rather than pooled estimation. Results: Three retrospective studies addressed limb fractures accompanying acute spinal cord injury, reporting benefits of operative management for selected fractures, with fracture-specific complications. Seven studies evaluated spinal decompression, spinal stabilization, resuscitation-guided skeletal surgery; early spinal decompression was associated with greater neurological recovery, and earlier stabilization frequently correlated with shorter hospitalization. Resuscitation-guided fixation correlated with fewer complications in observational comparisons, and immediate femoral nailing increased acute lung injury among physiologically borderline patients; none of the ten studies compared spine-first against fracture-first surgery in the combined-injury population. Conclusion: our findings supports early spinal decompression after stabilization of life-threatening injuries and fracture fixation guided by physiological recovery. The principal data gap concerns coordinated surgical sequencing, with neurological recovery, pulmonary complications, fracture healing, and rehabilitation requiring simultaneous consideration in future prospective comparative research in centers.
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