Effect of the Short Segment Internal Fixation with Intermediate Inclined Angle Poly Axial Screw at the Fractured Vertebra on the Treatment of Thoracolumbar Fracture at BPKIHS Dharan

Fixation at the fracture level along with short segment internal fixation (SSIF) increases the stability and efficacy more than that without the intermediate screw. Short segment internal fixation with straight forward monoaxial screws (SSIF-SFM) are paralleled with the endplate with a relatively short length and it cannot always provide sufficient mechanical support for the anterior column. This hospital-based longitudinal study was conducted for one year at Department of Orthopedics, BPKIHS, Dharan, patients with fracture at thoracolumbar (T1-L5) region without neurological impairment between age of 18 to 80 years who met the inclusion criteria were enrolled. The average duration of the surgery for SSIF-IAP, SSIF-SFM and LSIF were 1.9±0.5/hour, 1.9±0.4/hour and 2.6±0.6/hour respectively. The average length of incision for SSIF-IAP, SSIF-SFM and LSIF were 11.4±1.1cm, 12.3±1.1cm and 16.6±1.1cm respectively. The mean blood loss for SSIF-IAP, SSIF-SFM and LSIF were 214.6±32,7/ml, 245.3±33.9/ml and 301.2±26.9/ml respectively. The average duration of surgery, length of incision and blood loss in the SSIF-IAP group and SSIF-SFM group were significantly decreased compared with those in the LSIF group. The correction loss of AVBH AVBH (1 week) – AVBH (1 year) / AVBH (1 week) in the SSIF-SFM group and LSIF group were also decreased compared with those in the SSIF-IAP group at 6-months and the latest follow-up-1year (p < 0.05). The correction loss of the SCA SCA (1 week) – SCA (1 year) / SCA (1 week) in the SSIF-IAP group was decreased compared to those in the SSIF-SFM group and LSIF group. There were no significant differences among the three groups concerning correction loss of VBI. Both SSIF-IAP and LSIF can improve the biomechanical stability as compared with SSIF-SFM. However, SSIF-IAP was less extensive compared to LSIF, SSIF-IAP screw system could be an effective alternative way of fixation with satisfactory outcomes minimizing the number of fused levels and promoting rapid relief of back pain and early rehabilitation during the follow-up periods for patients with TL fracture.