Traumatic facet joint dislocation in Western Australia.

Abstract

Facet joint dislocation is a traumatic injury, which frequently results in devastating clinical outcomes. In Western Australia (WA), Royal Perth Hospital (RPH) provides a statewide Spinal Trauma Service and accepts all referrals from the entirety of the state. The economies of distance in WA mean that there is often a considerable delay between initial presentation at the peripheral hospital and enlocation of the dislocation in Perth. This study aims to identify any prejudicial clinical outcomes as a consequence of this delay. This study retrospectively examines all facet joint dislocations that presented to RPH between in a 46-month period. Data were collected on the demographics of patients, mechanism of injury, neurological assessment at presentation of injury based on the American spinal injury association (ASIA), initial presentation to RPH, post-surgical reduction and post rehabilitation. Over this time there were 23 urban patients and 28 rural patients. In the urban group, 18 patients had a final ASIA score of D or E while 5 patients had a final ASIA score of A, B or C. In the rural group, 17 patients had a final ASIA score of A, B or C while 11 patients had a final ASIA score of D or E. This study confirms the challenges of management of these injuries in a large geographical area, with a centralised spinal trauma service. Generally, facet joint dislocations that had delayed reductions had a poorer outcome. We hope that the proposed protocol would deliver better management of these injuries.