Évaluation du traitement orthopédique par corset des fractures du rachis thoraco-lombaire : à partir d'une série de 268 patients et revue de la littérature

Abstract : Thoraco-lumbar fractures are frequent pathological event. Without neurological deficit, these fractures can be treated by orthopaedic treatment with brace, or by surgical stabilization. The goal of our study was to evaluate the efficacy of orthopaedic treatment with brace of thoraco-lumbar fractures. We performed a retrospective monocentric study from 2016 to 2018. All patients with a thoraco-lumbar fracture classified A1 or A3.1 on Magerl score, with a local kyphosis less than 10 degrees, were included. Failure of brace treatment was defined by the need to perform surgery. We have then evaluated the risk factors of treatment’s failure. 268 patients were included, with a mean age of 57 years old, and male sex in 55% of the cases. Thirty patients (11%) have presented a brace treatment failure. The risk factors for brace treatment failure were: a fracture that occurred in the Manche department, a poor tolerance of the brace, a fewer number of follow- up consultation, and the absence of prescription of physical therapy. A.3.1 fracture and a corrected local angulation over 10 degrees might be a risk factor, but without reaching statistical significance. 11% of the patients with thoracolumbar fracture treated by brace required a surgery. Subsequently, patients must be informed of the risk of failure of the brace treatment. Identification of risk factor of failure allowed us to improve our practice: improve the brace tolerance with better brace adjustment, reorganize the follow up consultation more frequently and generalize physical therapy prescription. We can also discuss immediate surgery for A3.1 burst fracture and for fracture with corrected local angulation over 10°.
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Master Thesis
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Benjamin Guillard. Évaluation du traitement orthopédique par corset des fractures du rachis thoraco-lombaire : à partir d'une série de 268 patients et revue de la littérature. Médecine humaine et pathologie. 2018. ⟨dumas-02044444⟩

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