Should a patient with a T6 fracture, gibbus deformity, and abraded skin undergo surgical intervention?

Surgical Management of T6 Fracture with Gibbus Deformity and Abraded Skin

You should proceed with surgical intervention for this T6 fracture with gibbus deformity, but only after the abraded skin has been adequately treated and stabilized to minimize infection risk.

Immediate Preoperative Skin Management

The abraded, non-dry skin represents a critical barrier to immediate surgery and must be addressed first:

• Skin preparation is mandatory before any surgical intervention to prevent catastrophic infectious complications 1, 2
• The presence of skin breakdown over gibbus deformity significantly increases the risk of postoperative wound complications and deep infections 2, 3
• Consider wound care optimization, possible skin grafting, or tissue expansion techniques if the defect is substantial 2
• Do not operate through compromised skin - this dramatically increases infection rates and hardware complications 1, 2

Surgical Indications for T6 Fracture with Gibbus

Your patient meets clear criteria for surgical intervention:

• Upper thoracic fractures (T1-T6) with instability require surgical stabilization to prevent neurological deterioration and achieve anatomical reduction 4
• Gibbus deformity itself indicates significant anterior column collapse and biomechanical instability 5, 3
• The predictable progression of gibbus deformity without surgical intervention (correlation coefficient 0.83) makes early surgical correction essential to prevent severe kyphosis 5
• Surgical treatment decreases risk of further neurological complications, allows earlier mobilization, and correlates with shorter hospital stays 4

Surgical Approach and Technique

Once skin integrity is restored:

• Perform posterior instrumented fusion extending at least 2-3 levels above and below the fracture for adequate fixation 4
• Pedicle screw fixation with intraoperative fluoroscopy or CT navigation is the current standard, demonstrating 95% fusion rates with no intraoperative vascular or neurological complications 4
• Consider corpectomy with expandable cage placement if there is significant anterior column destruction 3
• For severe gibbus in younger patients, alternative techniques like rib-to-pelvis distraction may be considered, though this is primarily described in congenital deformities 2

Critical Timing Considerations

The abraded skin creates a surgical dilemma requiring staged management:

• Immediate surgery through compromised skin risks devastating infection with potential hardware contamination and osteomyelitis 1, 3
• However, delayed surgery risks progressive neurological deterioration and worsening deformity 4, 3
• The optimal approach: aggressive wound care with planned surgery within 1-2 weeks once skin integrity is restored 1
• If neurological deterioration occurs despite conservative management, surgery may be necessary even with suboptimal skin conditions, accepting higher infection risk 4, 3

Postoperative Management

Following successful surgery:

• Early mobilization should be initiated to prevent recumbency complications 4
• Monitor for wound complications given the pre-existing skin compromise 1, 2
• Serial radiographs to confirm maintenance of reduction and hardware position 4
• Extended antibiotic prophylaxis may be warranted given the pre-existing skin breakdown 3

Key Pitfall to Avoid

The single most critical error would be attempting immediate surgery through abraded, compromised skin - this virtually guarantees infectious complications that may necessitate hardware removal and result in worse outcomes than the original injury 1, 2, 3.