Session Title: Health Services Research
Session Type: Abstract Submissions (ACR)
Sublesional loss of bone mineral density is a common complication in patients with chronic spinal cord injury (SCI) putting them at high risk for low-impact fractures. Fracture management in patients with SCI is predominantly nonsurgical. However, to our knowledge, there are no large scale studies which report which nonsurgical procedures are most commonly used. The purpose of this study is to evaluate the distribution of nonsurgical treatments at different fracture sites in patients with SCI.
Males with chronic, traumatic SCI were identified from the Veterans Administration Spinal Cord Dysfunction data from fiscal years 2002-2007. From this population, patients with incident fractures were identified, excluding fractures due to external (“E-coded”) and pathologic fractures. Current Procedural Terminology (CPT) codes for nonsurgical treatments of fractures were collected and subsequently categorized into four categories: splints, casts, closed reduction without internal fixation, or “other.” The “other” category included knee immobilizers, walking boots, and other orthotic devices. These CPT codes were identified within six weeks following an incident upper extremity, lower extremity or unspecified fracture site. Differences in medical treatment modality were determined among fracture locations.
1,453 males with chronic traumatic SCI with non-traumatic and non-pathologic incident fractures were identified from 33,452 male SCI patients. 388 CPT codes for nonsurgical treatments of fracture were identified within 6 weeks post-fracture for 282 unique fractures. Fracture sites were grouped by number and location: single upper extremity, single lower extremity, single unspecified or multiple. Among fracture sites, there were significant differences among the types of nonsurgical treatments for single upper extremity fractures (P=0.017). Among single upper extremity fractures, forearm fractures were most frequently casted; carpal and metacarpal fractures, splinted; and phalangeal fractures, treated with closed reduction without internal fixation. In comparison, single lower extremity fractures were commonly treated with closed reduction for pelvic and femoral fractures; “other” for patellar, tibial/fibular, ankle, and tarsal/metatarsal fractures. Single unspecified fractures were frequently treated with closed reduction. In cases of multiple fractures, “other” outnumbered all other treatment modalities.
There are a number of different nonsurgical treatments done for single upper extremity, single lower extremity, single unspecified, and multiple fractures in men with chronic SCI.
This material is based upon work supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development and the Rheumatology Research Foundation, Ephraim P. Engleman Resident’s Preceptorship Award.
This work does not reflect the views of the Veterans Health Administration or the United States government.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/nonsurgical-treatment-patterns-in-patients-with-chronic-spinal-cord-injury/