Return to duty after non-surgical treatment of a non-neurological thoracic or lumbar spine fracture in French military patients: a retrospective analysis of 54 patients.

Abstract

Introduction: Non-surgical management of non-neurological thoracic or lumbar spine (TL) fractures seems to provide good results in the civilian population, leading to return to work in most cases. However, data on the military population are limited, particularly regarding return to duty. This study aimed to describe a population of French military patients with traumatic non-neurological TL fractures and the outcomes of non-surgical management regarding operational capacity.

Materials and methods: This retrospective single-centre observational study used data from military patients followed for non-neurological TL fractures, from the date of the trauma or after treatment in another civilian or military care facility. Medical fitness status at 1 year was the primary outcome. Medical fitness status at 1 year was defined as unrestricted resumption and restricted resumption in cases of return to duty in a different role or in the previous role with restrictions.

Results: Between January 2010 and December 2020, 93 patients presented with non-neurological traumatic TL fractures at Sainte-Anne National Military Hospital. Fifty-four records met the inclusion criteria. Falls from high heights (27.8%, n=15) and road accidents (24.1%, n=13) were the most common traumatic mechanisms. The remaining 77 injuries were compression fractures, predominantly at the thoracolumbar junction. One year after trauma, 90.7% of patients (n=49) had returned to duty, and 77.8% (n=42) were free from medical restriction. The median duration of incapacity (MDI) was 173 days. Age significantly affected medical fitness at 1 year (p=0.019); however, it did not affect the MDI. Polytrauma was significantly associated with a lower resumption rate at 1 year (53.3%, p=0.007).

Conclusion: Non-surgical management of non-neurological TL fractures allowed unrestricted return to duty in this population. These clinically relevant trends have led to perspectives for defining non-surgical treatment indications, means and goals.